Pedoortho Partners PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PEDOORTHO PARTNERS PLLC

Doing business as

Clubhouse Pediatric Dentistry

Practice address

5481 W 7800 S Ste 120
West Jordan, UT 84081-6027

Phone

(801) 542-0817

NPI assigned

Mar 22, 2022

Organization subpart

No

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

Authorized official

Name

Vicenta Reyes

Title

Credntialing ,Lead

Phone

(972) 869-3789

Specialties & licenses 1

Addresses

Other names 1

• Clubhouse Pediatric Dentistry Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bryce John Bott, D.M.D.

  • Pediatric Dentistry
  • Provo, UT
  • NPI 1811446727
  NPD (past)

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

{
    "created_epoch": "1647907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1639828007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5481 W 7800 S STE 120",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840816027",
            "telephone_number": "801-542-0817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5481 W 7800 S STE 120",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840816027",
            "telephone_number": "801-542-0817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDOORTHO PARTNERS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-22",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-22",
        "status": "A",
        "authorized_official_last_name": "REYES",
        "authorized_official_first_name": "VICENTA",
        "authorized_official_title_or_position": "CREDNTIALING ,LEAD",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clubhouse Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alyson C. Pearson, A.T., C.
• Chantal Peck
• Shawn Peck
• Sophia Peck
• Tamera Pedersen, CMHC
• Peggy Jerome LLC
• Juan Pena Cuevas
• Lynaya Pena
• Shandon James Pendleton, RDN
• Adaliz Perez

• Pediatric Dentistry in West Jordan, UT
• Providers in West Jordan, UT by specialty
• Pediatric Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; 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.