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General NPI Number Information
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NPI Number | 1275722357
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Entity Type | Organization
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Legal Business Name | UTAH SURGICAL ARTS
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 3610 N UNIVERSITY AVE SUITE 150
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City | PROVO
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State | UT
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Zip | 84604-4437
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Country | US
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Telephone | 801-356-2226
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Fax | 801-812-1734
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Provider Business Mailing Address
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Address Line | 3610 N UNIVERSITY AVE SUITE 150
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City | PROVO
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State | UT
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Zip | 84604-4437
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Country | US
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Telephone | 801-356-2226
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Fax | 801-812-1734
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Authorized Official
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Title or Position | ORAL/MAXILLOFACIAL SURGEON
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Name | DR. MICHAEL D HARRIS
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Credential | M.D., D.D.S.
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Telephone | 801-356-2226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 39634
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License Number State | UT
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