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General NPI Number Information
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NPI Number | 1194213074
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Entity Type | Organization
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Legal Business Name | LEHI ORAL SURGERY PC
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 2961 W MAPLE LOOP DR STE 130
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City | LEHI
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State | UT
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Zip | 84043-5717
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Country | US
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Telephone | 580-695-6280
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Fax |
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Provider Business Mailing Address
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Address Line | 2961 W MAPLE LOOP DR STE 130
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City | LEHI
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State | UT
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Zip | 84043-5717
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGIONAL LEADER
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Name | STEPHANIE GRIGG
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Credential | BSN, RN
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Telephone | 580-695-6280
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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 | 10226558-9924
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License Number State | UT
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