Provider Demographics
NPI:1194213074
Name:LEHI ORAL SURGERY PC
Entity Type:Organization
Organization Name:LEHI ORAL SURGERY PC
Other - Org Name:LEHI ORAL & FACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL LEADER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGG
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:580-695-6280
Mailing Address - Street 1:2961 W MAPLE LOOP DR STE 130
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2961 W MAPLE LOOP DR STE 130
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5717
Practice Address - Country:US
Practice Address - Phone:580-695-6280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10226558-99241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty