| Clubhouse Pediatric Dentistry Of Jackson | |
|
1130 Us-89 Jackson Hole WY 83001-8701 | |
| (307) 733-5439 | |
| Not Available |
| Full Name | Clubhouse Pediatric Dentistry Of Jackson |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1130 Us-89, Jackson Hole, Wyoming |
| Authorized Official Name and Position | Courtney Matthew Jackson (PEDIATRIC DENTIST) |
| Authorized Official Contact | 3077335439 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clubhouse Pediatric Dentistry Of Jackson 3210 E 81st S Idaho Falls ID 83406-8302 Ph: (307) 733-5439 | Clubhouse Pediatric Dentistry Of Jackson 1130 Us-89 Jackson Hole WY 83001-8701 Ph: (307) 733-5439 |
| NPI Number | 1942775960 |
|---|---|
| Provider Enumeration Date | 10/05/2018 |
| Last Update Date | 10/05/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942775960 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |