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

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 and National Provider Directory roles.

• Jeremy B Mahoney DMD LLC

  • 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.