Provider Demographics
NPI:1275722357
Name:UTAH SURGICAL ARTS
Entity Type:Organization
Organization Name:UTAH SURGICAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL/MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:801-356-2226
Mailing Address - Street 1:3610 N UNIVERSITY AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4437
Mailing Address - Country:US
Mailing Address - Phone:801-356-2226
Mailing Address - Fax:801-812-1734
Practice Address - Street 1:3610 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4437
Practice Address - Country:US
Practice Address - Phone:801-356-2226
Practice Address - Fax:801-812-1734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT39634261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery