Active NPI
Spencer Jacobson, DMD
- Pediatric Dentistry
- Heber City, UT
National Provider Identifier
1467149633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 7019303-9925
- Practice address
- 575 S 200 E
Heber City, UT 84032-5666 - Phone
- (435) 315-3080
- NPI assigned
- Apr 19, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 7019303-9925 | UT | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
575 S 200 E
Heber City, UT 84032-5666
Mailing address
4537 S Mossy Springs LN
Millcreek, UT 84117-6999
Phone (435) 851-4197
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7019303-9925 | UT | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1681862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761004800000",
"number": "1467149633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4537 S MOSSY SPRINGS LN",
"city": "MILLCREEK",
"state": "UT",
"postal_code": "841176999",
"telephone_number": "435-851-4197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "575 S 200 E",
"city": "HEBER CITY",
"state": "UT",
"postal_code": "840325666",
"telephone_number": "435-315-3080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "SPENCER",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-04-19",
"last_updated": "2025-10-21",
"certification_date": "2025-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Pediatric Dentistry",
"state": "UT",
"license": "7019303-9925",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Heber City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.