Matthew Jacobsen Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

83203479923 Issued in UT

Legal business name

MATTHEW JACOBSEN PEDIATRIC DENTISTRY

Doing business as

Jacobsen Pediatric Dentistry

Practice address

4019 W 12600 S Ste 200
Riverton, UT 84096-7406

Phone

(801) 302-7938

NPI assigned

Dec 8, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Matthew Vaughn Jacobsen, DDS

Title

Pediatric Dentist

Phone

(801) 589-3150

Specialties & licenses 1

Addresses

Other names 1

• Jacobsen Pediatric Dentistry Doing business as

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

{
    "created_epoch": "1449532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449532800000",
    "number": "1902271539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4019 W 12600 S STE 200",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840967406",
            "telephone_number": "801-302-7938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4019 W 12600 S STE 200",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840967406",
            "telephone_number": "801-302-7938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW JACOBSEN PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-08",
        "last_updated": "2015-12-08",
        "status": "A",
        "authorized_official_last_name": "JACOBSEN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "VAUGHN",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "801-589-3150",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "UT",
            "license": "83203479923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacobsen Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael Drew Martinez
• Christina Maruyama, NP
• Lauren Blaine Masche
• Michael John Mathews, D.P.T
• Ryan Mathews
• Kaitlyn Maxfield
• Richard G Maxwell, MD
• Grace Berry Maycock, C.S.W.
• Ryan James McAffee, D.D.S
• Candace McBride, APRN

• Pediatric Dentistry in Riverton, UT
• Providers in Riverton, UT by specialty
• Pediatric Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2015; 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.