Clubhouse Pediatric Dentistry of West Jordan
NPI 1639654684ActiveOrganization· Dentist, Pediatric Dentistry· Midvale, UT
Dentist, Pediatric Dentistry in Midvale, Utah, registered in NPPES in September 2018, part of Capstone LLC. The authorized official on file is Jennifer Louise Robison, Credentialing Coordinator.
Overview
| NPI | 1639654684 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Capstone LLC |
| NPI issued | Sep 26, 2018 |
| Last updated in NPPES | Sep 26, 2018 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, Pediatric Dentistry Primary | 1223P0221X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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