Organization
INSTITUTE OF FACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT D KENNEDY M.D. (DIRECTOR)
(801) 261-3637
Entity
Organization
Contact information
Practice address
5929 FASHION BLVD, MURRAY, UT 84107-7364
(801) 261-3637
(801) 261-4096
Mailing address
5929 FASHION BLVD, MURRAY, UT 84107-7364
(801) 261-3637
(801) 261-4096
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
2001ASF0602
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2001ASF0602
STATE LICENSE
UT
Enumeration date
04/12/2007
Last updated
08/22/2020
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