MEDICARE: DR. SAMIRA JAY OVESON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	28689	TX
2	122300000X	Dentist	61893	CA
3	122300000X	Dentist	11318168-9921	UT

General Provider Information

NPI Number	:	1033462817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMIRA JAY OVESON D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 521781
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84152-1781
Country	:	US
Telephone Number	:	801-828-5315
Fax Number	:

Provider Business Practice Location Address
First Line	:	1408 S 1100 E STE A
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2400
Country	:	US
Telephone Number	:	801-828-5315
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	02/01/2026

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