Provider Demographics
NPI:1326524851
Name:THE UTAH CENTER FOR SLEEP APNEA & TMJ, LLC
Entity Type:Organization
Organization Name:THE UTAH CENTER FOR SLEEP APNEA & TMJ, LLC
Other - Org Name:THE UTAH CENTER FOR SLEEP APNEA & TMJ, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:MILNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-376-3600
Mailing Address - Street 1:8119 W USTICK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5754
Mailing Address - Country:US
Mailing Address - Phone:208-376-3600
Mailing Address - Fax:208-376-3616
Practice Address - Street 1:6287 S REDWOOD RD STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-6653
Practice Address - Country:US
Practice Address - Phone:208-376-3600
Practice Address - Fax:208-376-3616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10868557-9921122300000X
1223G0001X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty