NPI 1790089886

Oral Surgery Specialty

Organisation Oral & Maxillofacial Surgery (D.M.D.) South Jordan, UT

Practice location

Address: 3648 W 9800 S, South Jordan, UT 84095-3260
Phone: (801) 397-2727
Mailing address: PO Box 367, Draper, UT 84020-0367

Authorised official

Name: L. Douglas Israelsen
Title: Owner
Phone: (801) 397-2727

Registered specialties

Oral & Maxillofacial Surgery (D.M.D.) Primary

Allopathic & Osteopathic Physicians Taxonomy 204E00000X Licence 135181 (UT)

Other Oral & Maxillofacial Surgery providers in Utah →

Registry record

NPI: 1790089886
Entity type: Organization
NPI issued: 4 Jan 2011
Record last updated: 22 Nov 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.