# DUSTIN B. WISE, M.D., P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lone Peak Pediatrics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932249299
- **Authorized official:** DUSTIN B. WISE M.D. (OWNER)
- **Authorized official phone:** (801) 492-7851

## Contact information

- **Practice address:** 1888 W 800 N, PLEASANT GROVE, UT 84062-4097
- **Practice address phone:** (801) 492-7851
- **Practice address fax:** (801) 492-7883
- **Mailing address:** 1888 W 800 N, PLEASANT GROVE, UT 84062-4097
- **Mailing address phone:** (801) 492-7851
- **Mailing address fax:** (801) 492-7883

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 5247966-1205 | UT | Yes |

## Other

- **Enumeration date:** 02/07/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 516086578002 | — | UT |