Healthcare Provider Details

I. General information

NPI: 1275722357
Provider Name (Legal Business Name): UTAH SURGICAL ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 N UNIVERSITY AVE SUITE 150
PROVO UT
84604-4437
US

IV. Provider business mailing address

3610 N UNIVERSITY AVE SUITE 150
PROVO UT
84604-4437
US

V. Phone/Fax

Practice location:
  • Phone: 801-356-2226
  • Fax: 801-812-1734
Mailing address:
  • Phone: 801-356-2226
  • Fax: 801-812-1734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number39634
License Number StateUT

VIII. Authorized Official

Name: DR. MICHAEL D HARRIS
Title or Position: ORAL/MAXILLOFACIAL SURGEON
Credential: M.D., D.D.S.
Phone: 801-356-2226