Organization
JEREMY B MAHONEY DMD LLC
Active
Other names
Copperfield Dental
Organization subpart
No
Provider details
NPI number
Authorized official
APRIL N PETERSEN (PRACTICE MANAGER)
(801) 566-0631
Entity
Organization
Contact information
Practice address
8846 S REDWOOD RD STE N201, WEST JORDAN, UT 84088-4702
(801) 566-0631
(801) 566-4826
Mailing address
8846 S REDWOOD RD STE N201, WEST JORDAN, UT 84088-4702
(801) 566-0631
(801) 566-4826
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1154705960
INSURANCE CO
—
Enumeration date
06/22/2021
Last updated
06/22/2021
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