Organization
ORAL SURGERY SPECIALTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. L. DOUGLAS ISRAELSEN DDS (OWNER)
(801) 397-2727
Entity
Organization
Contact information
Practice address
3648 W 9800 S, SOUTH JORDAN, UT 84095-3260
(801) 397-2727
Mailing address
PO BOX 367, DRAPER, UT 84020-0367
(801) 397-2727
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
135181
UT
Other
Enumeration date
01/04/2011
Last updated
11/22/2011
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