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General NPI Number Information
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NPI Number | 1831941095
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Entity Type | Organization
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Legal Business Name | ORAGEN IN-HOUSE SURGERY LLC
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Dates
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Enumeration Date | 04/02/2024
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | 11996 S ANTHEM PARK BLVD # 100
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City | HERRIMAN
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State | UT
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Zip | 84096-5643
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Country | US
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Telephone | 801-448-0366
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 285
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City | CENTERVILLE
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State | UT
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Zip | 84014-0285
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Country | US
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Telephone | 801-448-0366
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | WHITNEY PAVICK
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Credential |
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Telephone | 802-857-7947
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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 |
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License Number State |
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