MEDICARE: WEST VALLEY ORAL SURGERY PC

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)

General Provider Information

NPI Number	:	1962152884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST VALLEY ORAL SURGERY PC

Provider Business Mailing Address
First Line	:	1108 E SOUTH UNION AVE
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-2904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3715 W 4100 S STE 150
Second Line	:
City	:	WEST VALLEY
State	:	UT
Zip	:	84120-5552
Country	:	US
Telephone Number	:	801-285-9693
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAYNE JENSEN
Credential	:	MD, DMD
Telephone Number	:	801-698-7121

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	06/05/2025

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Directions to “WEST VALLEY ORAL SURGERY PC ” Practice Location

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