| Ut Oms Specialty Dental Services Pllc | |
|
777 N 500 W Ste 102 Provo UT 84601-1598 | |
| (801) 750-9672 | |
| Not Available |
| Full Name | Ut Oms Specialty Dental Services Pllc |
|---|---|
| Speciality | Dentist |
| Location | 777 N 500 W Ste 102, Provo, Utah |
| Authorized Official Name and Position | Charlotte V Dasch (DIRECTOR OF PROVIDER RELATIONS) |
| Authorized Official Contact | 6156780759 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ut Oms Specialty Dental Services Pllc 401 Church St Ste 1400 Nashville TN 37219-2214 Ph: (615) 678-0759 | Ut Oms Specialty Dental Services Pllc 777 N 500 W Ste 102 Provo UT 84601-1598 Ph: (801) 750-9672 |
| NPI Number | 1376206755 |
|---|---|
| Provider Enumeration Date | 10/21/2021 |
| Last Update Date | 10/21/2021 |
| Medicare PECOS PAC ID | 1850786112 |
|---|---|
| Medicare Enrollment ID | O20220323001638 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376206755 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | William L Mcbee |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1093898157 PECOS PAC ID: 3678761863 Enrollment ID: I20110104000185 |
| Provider Name | Gary L Crawford |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1649353715 PECOS PAC ID: 3072543818 Enrollment ID: I20110126000168 |
| Provider Name | Nathaniel Todd Edmunds |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1275067704 PECOS PAC ID: 5395191803 Enrollment ID: I20231019001465 |
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