Organization
STANSBURY PARK ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY B ELISON (PRESIDENT)
(435) 579-3800
Entity
Organization
Contact information
Practice address
263 COUNTRY CLUB, STE. 104, STANSBURY PARK, UT 84074
(435) 579-3800
(435) 579-3590
Mailing address
263 COUNTRY CLUB, STE. 104, STANSBURY PARK, UT 84074
(435) 579-3800
(435) 579-3590
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
04/23/2010
Last updated
04/23/2010
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