Provider Demographics
NPI:1720475650
Name:CENTER FOR FACIAL APPEARANCES, INC.
Entity Type:Organization
Organization Name:CENTER FOR FACIAL APPEARANCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-393-7254
Mailing Address - Street 1:9350 S 150 E
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2702
Mailing Address - Country:US
Mailing Address - Phone:801-997-9999
Mailing Address - Fax:801-561-0076
Practice Address - Street 1:9350 S 150 E
Practice Address - Street 2:SUITE 400
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2702
Practice Address - Country:US
Practice Address - Phone:801-997-9999
Practice Address - Fax:801-561-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1326006917Medicare PIN