Organization
MATTHEW JACOBSEN PEDIATRIC DENTISTRY
Active
Other names
Jacobsen Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW VAUGHN JACOBSEN DDS (PEDIATRIC DENTIST)
(801) 589-3150
Entity
Organization
Contact information
Practice address
4019 W 12600 S STE 200, RIVERTON, UT 84096-7406
(801) 302-7938
Mailing address
4019 W 12600 S STE 200, RIVERTON, UT 84096-7406
(801) 302-7938
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
83203479923
UT
Other
Enumeration date
12/08/2015
Last updated
12/08/2015
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