NPIMap

Organization Active NPI

South Hills Pediatric Dental Specialists, LLC

  • Pediatric Dentistry
  • Riverton, UT
National Provider Identifier
1730714783
Registry record updated Mar 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
SOUTH HILLS PEDIATRIC DENTAL SPECIALISTS, LLC
Practice address
4013 W 13400 S
Riverton, UT 84096-6410
Phone
(385) 210-1000
NPI assigned
Mar 10, 2020
Last updated
Mar 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2020

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

Authorized official

Name
Dr. Matthew Jacobsen, DDSNPI 1952659708
Title
Owner
Phone
(801) 589-3150

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

4013 W 13400 S
Riverton, UT 84096-6410

Mailing address

4013 W 13400 S
Riverton, UT 84096-6410
Phone (385) 210-1000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Dr.bart@southhillspediatricdentistry.com Direct

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: dr.bart@southhillspediatricdentistry.com

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1583798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583798400000",
    "number": "1730714783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4013 W 13400 S",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840966410",
            "telephone_number": "385-210-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4013 W 13400 S",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840966410",
            "telephone_number": "385-210-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH HILLS PEDIATRIC DENTAL SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-10",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A",
        "authorized_official_last_name": "JACOBSEN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-589-3150",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Dr.bart@southhillspediatricdentistry.com",
            "affiliation": "N",
            "endpointDescription": "Hipaa compliant email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4013 W 13400 S",
            "city": "Riverton",
            "state": "UT",
            "country_code": "US",
            "postal_code": "840966410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Riverton, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; 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.