Organization
UTAH & ORAL & FACIAL SURGEONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALVIN JOHN STOSICH DDS, MD (OWNER)
(801) 566-5117
Entity
Organization
Contact information
Practice address
6268 S 900 E, 100, SALT LAKE CITY, UT 84121-2497
(801) 566-5117
(801) 566-5119
Mailing address
6268 S 900 E, 100, SALT LAKE CITY, UT 84121-2497
(801) 566-5117
(801) 566-5119
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
64341369924
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127067200
—
WY
05
—
519239432001
—
UT
Enumeration date
09/10/2015
Last updated
09/10/2015
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