Healthcare Provider Details

I. General information

NPI: 1962152884
Provider Name (Legal Business Name): WEST VALLEY ORAL SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 W 4100 S STE 150
WEST VALLEY UT
84120-5552
US

IV. Provider business mailing address

1108 E SOUTH UNION AVE
MIDVALE UT
84047-2904
US

V. Phone/Fax

Practice location:
  • Phone: 801-285-9693
  • Fax:
Mailing address:
  • Phone:
  • 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: DR. DAYNE JENSEN
Title or Position: OWNER
Credential: MD, DMD
Phone: 801-698-7121