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General NPI Number Information
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NPI Number | 1962918094
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Entity Type | Organization
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Legal Business Name | SOUTHERN UTAH SURGICAL ARTS
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Dates
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Enumeration Date | 12/27/2017
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Last Update Date | 12/27/2017
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Provider Practice Location Address
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Address Line | 393 E RIVERSIDE DR, STE 2B
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City | ST. GEORGE
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State | UT
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Zip | 84790
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Country | US
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Telephone | 435-628-1100
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Fax | 435-673-0330
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Provider Business Mailing Address
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Address Line | 393 E RIVERSIDE DR, STE 2B
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City | ST GEORGE
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State | UT
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Zip | 84790
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Country | US
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Telephone | 435-628-1100
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Fax | 435-673-0330
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAWN B DAVIS
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Credential | DMD
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Telephone | 435-628-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | D07932
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 6524667
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License Number State | UT
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