# ORAL SURGERY SPECIALTY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790089886
- **Authorized official:** DR. L. DOUGLAS ISRAELSEN DDS (OWNER)
- **Authorized official phone:** (801) 397-2727

## Contact information

- **Practice address:** 3648 W 9800 S, SOUTH JORDAN, UT 84095-3260
- **Practice address phone:** (801) 397-2727
- **Mailing address:** PO BOX 367, DRAPER, UT 84020-0367
- **Mailing address phone:** (801) 397-2727

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 135181 | UT | Yes |

## Other

- **Enumeration date:** 01/04/2011
- **Last updated:** 11/22/2011