Active NPI
Jeffrey Brian Roberson, DDS
- Dentist
- West Jordan, UT
National Provider Identifier
1710116041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7368949-9922
- Practice address
- 9217 S Redwood Rd
West Jordan, UT 84088-5826 - Phone
- (801) 566-1873
- NPI assigned
- Jul 8, 2009
- Last updated
- Jul 8, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7368949-9922 | UT | Primary |
Addresses
Primary practice location
9217 S Redwood Rd
West Jordan, UT 84088-5826
Mailing address
1222 Scots Field CT
Murray, UT 84123-2654
Phone (801) 699-9219
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 |
|---|---|---|---|
| 7368949-9922 | UT | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247011200000",
"number": "1710116041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1222 SCOTS FIELD CT",
"city": "MURRAY",
"state": "UT",
"postal_code": "841232654",
"telephone_number": "801-699-9219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9217 S REDWOOD RD",
"city": "WEST JORDAN",
"state": "UT",
"postal_code": "840885826",
"telephone_number": "801-566-1873"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERSON",
"first_name": "JEFFREY",
"middle_name": "BRIAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-08",
"last_updated": "2009-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "7368949-9922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Jordan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.