Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI # | 1497498158 |
| LBN Legal business name | CEDAR CITY RED ROCKS PC |
| Authorized official | DAYNE JENSEN - (ORAL SURGEON/OWNER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 04/19/2022 |
| Last updated | 04/19/2022 - About 4 years ago |
| Identifiers | n/a |
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