Organization
CLUBHOUSE PEDIATRIC DENTISTRY OF WEST JORDAN
Active
Parent organization
CAPSTONE LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CAPSTONE LLC
Authorized official
MRS. JENNIFER LOUISE ROBISON (CREDENTIALING COORDINATOR)
(208) 520-1514
Entity
Organization
Contact information
Practice address
1108 E SOUTH UNION AVE, MIDVALE, UT 84047-2904
(208) 520-1514
Mailing address
1108 E SOUTH UNION AVE, MIDVALE, UT 84047-2904
(208) 520-1514
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
09/26/2018
Last updated
09/26/2018
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