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Organization
EXCEL COSMETIC SURGERY CENTER
Active
Organization
EXCEL COSMETIC SURGERY CENTER
Active
Other names
Central Utah Eye Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DALE BLAKE (ADMINISTRATOR)
(801) 374-1818
Entity
Organization
Contact information
Practice address
1735 N STATE ST, PROVO, UT 84604-1010
(801) 379-2900
(801) 374-6295
Mailing address
1735 N STATE ST, PROVO, UT 84604-1010
(801) 379-2900
(801) 374-6295
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
3591001205
UT
Other
Enumeration date
03/09/2007
Last updated
08/19/2008
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