| Utah & Oral & Facial Surgeons | |
|
6268 S 900 E 100 Salt Lake City UT 84121-2497 | |
| (801) 566-5117 | |
| (801) 566-5119 |
| Full Name | Utah & Oral & Facial Surgeons |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 6268 S 900 E, Salt Lake City, Utah |
| Authorized Official Name and Position | Alvin John Stosich (OWNER) |
| Authorized Official Contact | 8015665117 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Utah & Oral & Facial Surgeons 6268 S 900 E 100 Salt Lake City UT 84121-2497 Ph: (801) 566-5117 | Utah & Oral & Facial Surgeons 6268 S 900 E 100 Salt Lake City UT 84121-2497 Ph: (801) 566-5117 |
| NPI Number | 1063880896 |
|---|---|
| Provider Enumeration Date | 09/10/2015 |
| Last Update Date | 09/10/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063880896 | NPI | - | NPPES |
| 519239432001 | Medicaid | UT | |
| 127067200 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 64341369924 (Utah) | Primary |
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