MEDICARE: FLINT & STEEL SURGICAL

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	6434136-9924	UT

General Provider Information

NPI Number	:	1497124259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLINT & STEEL SURGICAL

Provider Business Mailing Address
First Line	:	4970 S 900 E
Second Line	:	SUITE C
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5776
Country	:	US
Telephone Number	:	801-263-3309
Fax Number	:	801-288-1226

Provider Business Practice Location Address
First Line	:	4970 S 900 E
Second Line	:	SUITE C
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5776
Country	:	US
Telephone Number	:	801-263-3309
Fax Number	:	801-288-1226

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALVIN JOHN STOSICH
Credential	:	MD, DDS
Telephone Number	:	801-566-5117

Provider Enumeration Date	:	09/22/2015
Last Update Date	:	09/22/2015

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Directions to “FLINT & STEEL SURGICAL ” Practice Location

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