Provider Demographics
NPI:1083451496
Name:RISE PARK CITY PLLC
Entity type:Organization
Organization Name:RISE PARK CITY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:OSORIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-214-0544
Mailing Address - Street 1:5240 HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5967
Mailing Address - Country:US
Mailing Address - Phone:321-271-8201
Mailing Address - Fax:
Practice Address - Street 1:1800 PROSPECTOR AVE
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7319
Practice Address - Country:US
Practice Address - Phone:435-214-0544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental