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General NPI Number Information
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NPI Number | 1104969062
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Entity Type | Organization
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Legal Business Name | UTAH VALLEY ORAL AND MAXILLOFACIAL SURGERY,LLC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 480 W 800 N
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City | OREM
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State | UT
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Zip | 84057-3745
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Country | US
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Telephone | 801-224-1200
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Fax | 801-224-6890
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Provider Business Mailing Address
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Address Line | 480 W 800 N
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City | OREM
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State | UT
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Zip | 84057-3745
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Country | US
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Telephone | 801-224-1200
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Fax | 801-224-6890
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER C BURTON
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Credential | D.D.S.,M.S.
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Telephone | 801-224-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 376241-9924
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License Number State | UT
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