Organization
WISE CLEFT CENTER FOR EXCELLENCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAVIN LAWRENCE (DIRECTOR OF DEVELOPMENT)
(435) 669-7660
Entity
Organization
Contact information
Practice address
11762 S STATE ST STE 110, DRAPER, UT 84020-7158
(385) 977-8125
Mailing address
11762 S STATE ST STE 110, DRAPER, UT 84020-7158
(385) 218-0587
(385) 381-4447
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
06/13/2024
Last updated
02/20/2025
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