Healthcare Provider Details

I. General information

NPI: 1396675005
Provider Name (Legal Business Name): SEXTON OMFS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 N 500 W STE 103
PROVO UT
84601-1475
US

IV. Provider business mailing address

2082 N 420 E
PROVO UT
84604-1805
US

V. Phone/Fax

Practice location:
  • Phone: 865-206-0614
  • Fax:
Mailing address:
  • Phone: 865-206-0614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DWIGHT SEXTON
Title or Position: OWNER
Credential: DDS
Phone: 865-206-0614