Organization
JESSEN OMFS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY SHANE JESSEN DDS (OWNER)
(801) 479-8200
Entity
Organization
Contact information
Practice address
1508 E SKYLINE DR, SUITE 800, OGDEN, UT 84405-4846
(801) 479-8200
(801) 479-3219
Mailing address
1508 E SKYLINE DR, SUITE 800, OGDEN, UT 84405-4846
(801) 479-8200
(801) 479-3219
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
52199299924
UT
Other
Enumeration date
11/23/2011
Last updated
10/17/2023
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