Provider Demographics
NPI:1790012243
Name:SOUTHERN UTAH SURGICAL ARTS
Entity Type:Organization
Organization Name:SOUTHERN UTAH SURGICAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:DRESHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-848-7974
Mailing Address - Street 1:5600 N MAY AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3973
Mailing Address - Country:US
Mailing Address - Phone:405-848-7974
Mailing Address - Fax:405-848-0033
Practice Address - Street 1:393 E RIVERSIDE DR BLDG 2
Practice Address - Street 2:SUITE 2B
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7065
Practice Address - Country:US
Practice Address - Phone:435-628-1100
Practice Address - Fax:435-673-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT65244671223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty