| Bountiful Oral Surgery, P.C. | |
|
625 E 500 S Ste 204 Bountiful UT 84010-3883 | |
| (801) 298-2242 | |
| (801) 294-9920 |
| Full Name | Bountiful Oral Surgery, P.C. |
|---|---|
| Speciality | Dentist |
| Location | 625 E 500 S Ste 204, Bountiful, Utah |
| Authorized Official Name and Position | Travis Sorensen (OWNER) |
| Authorized Official Contact | 8013805016 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bountiful Oral Surgery, P.C. 625 E 500 S Ste 204 Bountiful UT 84010-3883 Ph: (801) 298-2242 | Bountiful Oral Surgery, P.C. 625 E 500 S Ste 204 Bountiful UT 84010-3883 Ph: (801) 298-2242 |
| NPI Number | 1861147100 |
|---|---|
| Provider Enumeration Date | 02/15/2022 |
| Last Update Date | 05/27/2025 |
| Certification Date | 05/27/2025 |
| Medicare PECOS PAC ID | 5991210494 |
|---|---|
| Medicare Enrollment ID | O20250714003715 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861147100 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | () | Primary |
| Provider Name | Travis Sorensen |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1679878938 PECOS PAC ID: 7315251485 Enrollment ID: I20250714003768 |
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