Provider Demographics
NPI:1518186188
Name:THE ORAL & FACIAL SURGERY CENTER
Entity Type:Organization
Organization Name:THE ORAL & FACIAL SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NEWEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-825-1116
Mailing Address - Street 1:938 S. UNIVERSITY PARK BLVD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015
Mailing Address - Country:US
Mailing Address - Phone:801-825-1116
Mailing Address - Fax:801-825-1310
Practice Address - Street 1:938 S 2000 E
Practice Address - Street 2:SUITE 100
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-6282
Practice Address - Country:US
Practice Address - Phone:801-825-1116
Practice Address - Fax:801-825-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2801521223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty