Provider Demographics
NPI:1104969062
Name:UTAH VALLEY ORAL AND MAXILLOFACIAL SURGERY,LLC
Entity type:Organization
Organization Name:UTAH VALLEY ORAL AND MAXILLOFACIAL SURGERY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:801-224-1200
Mailing Address - Street 1:480 W 800 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-3745
Mailing Address - Country:US
Mailing Address - Phone:801-224-1200
Mailing Address - Fax:801-224-6890
Practice Address - Street 1:480 W 800 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-3745
Practice Address - Country:US
Practice Address - Phone:801-224-1200
Practice Address - Fax:801-224-6890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT376241-99241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty