Individual
DR. JEFFREY AVARON OSGUTHORPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
4645 S 4000 W STE B, WEST VALLEY, UT 84120-6250
(801) 550-5103
Mailing address
4645 S 4000 W STE B, WEST VALLEY, UT 84120-6250
(801) 550-5103
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2901018951
MI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
4947070-9924
UT
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
2901018951
MI
Other
Enumeration date
11/06/2006
Last updated
04/15/2019
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