# PEDOORTHO PARTNERS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Clubhouse Pediatric Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639828007
- **Authorized official:** VICENTA REYES (CREDNTIALING ,LEAD)
- **Authorized official phone:** (972) 869-3789

## Contact information

- **Practice address:** 5481 W 7800 S STE 120, WEST JORDAN, UT 84081-6027
- **Practice address phone:** (801) 542-0817
- **Mailing address:** 5481 W 7800 S STE 120, WEST JORDAN, UT 84081-6027
- **Mailing address phone:** (801) 542-0817

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 03/22/2022
- **Last updated:** 03/22/2022