Healthcare Provider Details

I. General information

NPI: 1104969062
Provider Name (Legal Business Name): UTAH VALLEY ORAL AND MAXILLOFACIAL SURGERY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 W 800 N
OREM UT
84057-3745
US

IV. Provider business mailing address

480 W 800 N
OREM UT
84057-3745
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-1200
  • Fax: 801-224-6890
Mailing address:
  • Phone: 801-224-1200
  • Fax: 801-224-6890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number376241-9924
License Number StateUT

VIII. Authorized Official

Name: DR. CHRISTOPHER C BURTON
Title or Position: OWNER
Credential: D.D.S.,M.S.
Phone: 801-224-1200