NPI age
7 years
Enumerated 2018-09-26
● Active Type 2 · Organization
Clubhouse Pediatric Dentistry Of Madison
Clubhouse Pediatric Dentistry Of Madison is 1 of 114 dentist organizations in Idaho.
Primary specialty
Dentist
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Robison
Financial Coordinator
Last NPPES update
2018-09-26
Source: monthly bulk 2026-05
How this organization compares
Across 114 active dentist providers in Idaho.
NPI age
7 years
↓ 6 yr below median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2018 → 2026
2018-09Enumerated in NPPES
2018
2026
Where they practice
Primary practice location
859 S Yellowstone Hwy
Rexburg, ID 834405293
Mailing address
859 S Yellowstone Hwy
Rexburg, ID 834405293
Authorized official
Jennifer Louise Robison
Financial Coordinator
📞 2085201514
Individual providers at this organization
8 individual providers on file at this primary practice address.
- Brianne Banks, SLP Speech-Language Pathologist NPI 1659997138
- Rachel Batemon Speech-Language Pathologist NPI 1063948610
- Jeffrey Despot, MS CF-SLP Speech-Language Pathologist NPI 1750019675
- Laura Dolezal, CCC/SLP Speech-Language Pathologist NPI 1750798526
- Kevin Keller Speech-Language Pathologist NPI 1811725377
- Spencer Mauseth, D.D.S. Dentist NPI 1619187390
- Sarah Panting, M.S., CCC-SLP Speech-Language Pathologist NPI 1801243506
- Amanda White Behavior Technician NPI 1538995626
Specialties
-
Dentist PrimaryAn age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 28954 |
Practice context
Multi-provider organization. 8 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.