| Jessen Omfs Inc | |
|
1508 E Skyline Dr Suite 800 Ogden UT 84405-4846 | |
| (801) 479-8200 | |
| (801) 479-3219 |
| Full Name | Jessen Omfs Inc |
|---|---|
| Speciality | Dentist |
| Location | 1508 E Skyline Dr, Ogden, Utah |
| Authorized Official Name and Position | Gregory Shane Jessen (OWNER) |
| Authorized Official Contact | 8014798200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jessen Omfs Inc 1508 E Skyline Dr Suite 800 Ogden UT 84405-4846 Ph: (801) 479-8200 | Jessen Omfs Inc 1508 E Skyline Dr Suite 800 Ogden UT 84405-4846 Ph: (801) 479-8200 |
| NPI Number | 1184991895 |
|---|---|
| Provider Enumeration Date | 11/23/2011 |
| Last Update Date | 10/17/2023 |
| Medicare PECOS PAC ID | 4082873435 |
|---|---|
| Medicare Enrollment ID | O20120305000634 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184991895 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 52199299924 (Utah) | Primary |
| Provider Name | Gregory Shane Jessen |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1548349251 PECOS PAC ID: 6507894177 Enrollment ID: I20050803001115 |
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