Jeremy Bruce Mahoney, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9823805-9922 Issued in UT

Practice address

8846 S Redwood Rd Ste N201
West Jordan, UT 84088-4702

Phone

(801) 566-0631

NPI assigned

May 3, 2016

Last updated

Feb 24, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Networks

• UT PPO D-SNP

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jeremy B Mahoney DMD LLC

  dba Copperfield Dental

  • Dental Clinic/Center
  • West Jordan, UT
  • NPI 1770152985
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614124800000",
    "number": "1083069561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8846 S REDWOOD RD STE N201",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840884702",
            "telephone_number": "801-566-0631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8846 S REDWOOD RD STE N201",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840884702",
            "telephone_number": "801-566-0631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHONEY",
        "first_name": "JEREMY",
        "middle_name": "BRUCE",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-03",
        "last_updated": "2021-02-24",
        "certification_date": "2021-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "UT",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "9823805-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kassidy Madison
• Denise Madsen, LPC
• Jason Madsen
• Josie Madsen
• Kanoelani Magner
• Ashley Majoskey, PA-C
• Anne Malbica
• Shelley F Mangum, CMHC
• Jade Mangus, CSW
• Matteus Manzo

• General Practice Dentistry in West Jordan, UT
• Providers in West Jordan, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.