Healthcare Provider Details

I. General information

NPI: 1962038711
Provider Name (Legal Business Name): STANLEY ORAL & FACIAL SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3632 W SOUTH JORDAN PKWY STE 103
SOUTH JORDAN UT
84009-7163
US

IV. Provider business mailing address

3632 W SOUTH JORDAN PKWY STE 103
SOUTH JORDAN UT
84009-7163
US

V. Phone/Fax

Practice location:
  • Phone: 385-274-4848
  • Fax: 385-274-4845
Mailing address:
  • Phone: 385-274-4848
  • Fax: 385-274-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ADAM C STANLEY
Title or Position: OWNER/ORAL SURGEON
Credential: DDS
Phone: 385-274-4848