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4970 S 900 E Suite C Salt Lake City UT 84117-5776 | |
| (801) 263-3309 | |
| (801) 288-1226 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 4970 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 |
|---|---|
4970 S 900 E Suite C Salt Lake City UT 84117-5776 Ph: (801) 263-3309 | 4970 S 900 E Suite C Salt Lake City UT 84117-5776 Ph: (801) 263-3309 |
| NPI Number | 1497124259 |
|---|---|
| Provider Enumeration Date | 09/22/2015 |
| Last Update Date | 09/22/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497124259 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 6434136-9924 (Utah) | Primary |
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