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Individual

DR. ALVIN J STOSICH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD, DDS

Contact information

Practice address
6268 S 900 E, STE 100, SALT LAKE CITY, UT 84121-2497
(801) 566-5117
(801) 566-5119
Mailing address
6268 S 900 E, STE 100, SALT LAKE CITY, UT 84121-2497
(801) 566-5117
(801) 566-5119

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
6434136-9925
UT
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
6395
NE
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
6434136-1205
UT

Other

Enumeration date
04/02/2007
Last updated
11/01/2021
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