Healthcare Provider Details

I. General information

NPI: 1548792468
Provider Name (Legal Business Name): ASPIRE SURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6268 S 900 E SUITE 100
SALT LAKE CITY UT
84121-2497
US

IV. Provider business mailing address

6268 S 900 E SUITE 100
SALT LAKE CITY UT
84121-2497
US

V. Phone/Fax

Practice location:
  • Phone: 801-566-5117
  • Fax: 801-566-5119
Mailing address:
  • Phone: 801-566-5117
  • Fax: 801-566-5119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: JAMIE HOROWITZ
Title or Position: INSURANCE MANAGER
Credential:
Phone: 801-566-5117