Provider Demographics
NPI:1619736535
Name:TMJ AND SLEEP THERAPY OF UTAH LLC
Entity Type:Organization
Organization Name:TMJ AND SLEEP THERAPY OF UTAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUNNERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-360-4246
Mailing Address - Street 1:33 WEST 300 SOUTH
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651
Mailing Address - Country:US
Mailing Address - Phone:801-465-3233
Mailing Address - Fax:801-331-0013
Practice Address - Street 1:33 WEST 300 SOUTH
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651
Practice Address - Country:US
Practice Address - Phone:801-465-3233
Practice Address - Fax:801-331-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center