Healthcare Provider Details

I. General information

NPI: 1770407686
Provider Name (Legal Business Name): MILLARD COUNTY ORAL & FACIAL SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 WHITE SAGE AVE
DELTA UT
84624-5555
US

IV. Provider business mailing address

86 WHITE SAGE AVE
DELTA UT
84624-5555
US

V. Phone/Fax

Practice location:
  • Phone: 435-554-1400
  • Fax:
Mailing address:
  • Phone: 435-554-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: WHITNEY PAVICK
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 435-554-1400