Organization
ORTHODONTIC CENTER
Active
Organization
ORTHODONTIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY B ELISON DMD (PRESIDENT)
(801) 446-3549
Entity
Organization
Contact information
Practice address
3556 W 9800 S, SUITE 103, SOUTH JORDAN, UT 84095
(801) 446-3549
(801) 254-3656
Mailing address
3556 W 9800 S, SUITE 103, SOUTH JORDAN, UT 84095
(801) 446-3549
(801) 254-3656
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
12/11/2006
Last updated
08/22/2020
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