# MATTHEW JACOBSEN PEDIATRIC DENTISTRY

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

## Provider details

- **NPI number:** 1902271539
- **Authorized official:** DR. MATTHEW VAUGHN JACOBSEN DDS (PEDIATRIC DENTIST)
- **Authorized official phone:** (801) 589-3150

## Contact information

- **Practice address:** 4019 W 12600 S STE 200, RIVERTON, UT 84096-7406
- **Practice address phone:** (801) 302-7938
- **Mailing address:** 4019 W 12600 S STE 200, RIVERTON, UT 84096-7406
- **Mailing address phone:** (801) 302-7938

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 83203479923 | UT | Yes |

## Other

- **Enumeration date:** 12/08/2015
- **Last updated:** 12/08/2015