Organization
EXCEL COSMETIC SURGERY CENTER
Active
Other names
Central Utah Eye Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DALE BLAKE (ADMINISTRATOR)
(801) 374-1818
Entity
Organization
Contact information
Practice address
1735 N STATE ST, PROVO, UT 84604-1010
(801) 379-2900
(801) 374-6295
Mailing address
1735 N STATE ST, PROVO, UT 84604-1010
(801) 379-2900
(801) 374-6295
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
3591001205
UT
Other
Enumeration date
03/09/2007
Last updated
08/19/2008
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