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General NPI Number Information
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NPI Number | 1619736535
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Entity Type | Organization
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Legal Business Name | TMJ AND SLEEP THERAPY OF UTAH LLC
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Dates
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Enumeration Date | 03/14/2024
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 33 WEST 300 SOUTH
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City | PAYSON
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State | UT
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Zip | 84651
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Country | US
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Telephone | 801-465-3233
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Fax | 801-331-0013
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Provider Business Mailing Address
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Address Line | 33 WEST 300 SOUTH
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City | PAYSON
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State | UT
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Zip | 84651
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Country | US
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Telephone | 801-465-3233
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Fax | 801-331-0013
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Authorized Official
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Title or Position | CEO/PROVIDER/OWNER
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Name | KRISTOPHER C GUNNERSON
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Credential | DMD
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Telephone | 801-360-4246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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