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1268 W South Jordan Pkwy Suite 200 South Jordan UT 84095-4652 | |
| (801) 561-8088 | |
| (801) 562-8286 |
| Full Name | |
|---|---|
| Speciality | Oral & Maxillofacial Surgery |
| Location | 1268 W South Jordan Pkwy, South Jordan, Utah |
| Authorized Official Name and Position | Kyle S Christensen (OWNER) |
| Authorized Official Contact | 8015618088 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1268 W South Jordan Pkwy Suite 200 South Jordan UT 84095-4652 Ph: (801) 561-8088 | 1268 W South Jordan Pkwy Suite 200 South Jordan UT 84095-4652 Ph: (801) 561-8088 |
| NPI Number | 1669662425 |
|---|---|
| Provider Enumeration Date | 07/27/2007 |
| Last Update Date | 07/27/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669662425 | NPI | - | NPPES |
| 550719194003 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Secondary |
| 204E00000X | Oral & Maxillofacial Surgery | (* (Not Available)) | Primary |
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