Organization
PLASTICS CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIM PRUSSE (MANAGER)
(801) 386-1337
Entity
Organization
Contact information
Practice address
1309 W SOUTH JORDAN PKWY STE 110, SOUTH JORDAN, UT 84095-9014
(801) 839-5557
(801) 770-4455
Mailing address
1309 W SOUTH JORDAN PKWY STE 110, SOUTH JORDAN, UT 84095-9014
(801) 839-5557
(801) 770-4455
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
06/06/2023
Last updated
10/31/2023
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