Organization
ORAGEN IN-HOUSE SURGERY LLC
Active
Other names
In-House Oral Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
WHITNEY PAVICK (DIRECTOR OF OPERATIONS)
(802) 857-7947
Entity
Organization
Contact information
Practice address
11996 S ANTHEM PARK BLVD # 100, HERRIMAN, UT 84096-5643
(801) 448-0366
Mailing address
PO BOX 285, CENTERVILLE, UT 84014-0285
(801) 448-0366
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
04/02/2024
Last updated
04/02/2024
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