Healthcare Provider Details

I. General information

NPI: 1326524851
Provider Name (Legal Business Name): UTAH CENTER FOR SLEEP APNEA & TMJ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10654 S RIVER HEIGHTS DR STE 240
SOUTH JORDAN UT
84095-5541
US

IV. Provider business mailing address

10654 S RIVER HEIGHTS DR STE 240
SOUTH JORDAN UT
84095-5541
US

V. Phone/Fax

Practice location:
  • Phone: 801-261-9155
  • Fax: 801-261-9158
Mailing address:
  • Phone: 801-261-9155
  • Fax: 801-261-9158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10868557-9921
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN MANGELSON
Title or Position: DENTIST
Credential: DMD
Phone: 801-261-9155