LEGACY HEIGHTS ORAL & FACIAL SURGERY PLLC (NPI# 1912507153) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912507153 |
| Entity Type | Organization |
| Organization Name | LEGACY HEIGHTS ORAL & FACIAL SURGERY PLLC |
| Practice Address |
193 S 200 W Ste B Farmington UT 84025-2406 |
| Practice Telephone | 8016987121 |
| Mailing Telephone | 8016987121 |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2020-10-27 |
| Authorized Official Name | DAYNE ROBERT JENSEN (OWNER/ORAL SURGEON) |
| Authorized Official Telephone | 8016987121 |
| Authorized Official Credential | MD, DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QS0112X |
Clinic/Center Specialization: Oral and Maxillofacial Surgery |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Legacy Heights Oral & Facial Surgery | Doing Business As Name - Organization |
| Street Address |
193 S 200 W STE B |
| City | FARMINGTON |
| State | UT |
| Zip Code | 84025-2406 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013522200 | Kim Nguyen | Behavior Technician | 1148 N Wilow Wind Rd Unit 9, Farmington, UT 84025 | 2020-09-14 |
| 1164980181 | Adam Thomas Creer | Nurse Practitioner | 696 N 40 E Apt 2, Farmington, UT 84025 | 2019-03-08 |
| 1881100550 | Lindsay Case | Counselor | 1645 W 1440 N, Farmington, UT 84025 | 2017-12-18 |
| 1447707955 | Joseph Daniel Levie | Chiropractor | 63 N. Main Street, Farmington, UT 84025 | 2016-09-01 |
| 1649724139 | University of Utah Adult Services | Dermatology | 165 N. University Ave. Farmington, Farmington, UT 84025 | 2016-08-12 |
| 1679931075 | Rhodes Physical Therapy, Inc | Clinic/Center | 722 W. Shepard Lane Suite 105, Farmington, UT 84025 | 2016-02-01 |
| 1760847552 | Polished Holdings, Inc. | Specialist | 491 W. Bourne Circle, Suite 2, Farmington, UT 84025 | 2015-12-21 |
| 1568833911 | Ageless Men's Health Holdings, LLC | Specialist | 491 West Bourne Circle, Suite 2, Farmington, UT 84025 | 2015-10-12 |
| 1588053300 | Onsyte Surgical of Nevada, LLC | Clinic/Center | 1262 S 650 W Suite 1d, Farmington, UT 84025 | 2015-01-16 |
| 1568879872 | Laura Cook | Counselor | 1200 West Red Barn Lane, Farmington, UT 84025 | 2014-07-18 |
| Find all providers in zip 84025 | ||||
| Taxonomy Code | 261QS0112X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598024341 | Logan Oral Surgery | Clinic/Center | 3125 N. Main Street, Ste #103, North Logan, UT 84341-1550 | 2012-05-15 |
| 1962038711 | Stanley Oral & Facial Surgery Pllc | Clinic/Center | 3632 W South Jordan Pkwy Ste 103, South Jordan, UT 84009-7163 | 2020-03-12 |
| 1851937270 | Randy Sean Barnhisel Dds, Pllc | Clinic/Center | 4970 S 900 E Ste G, Salt Lake City, UT 84117-3930 | 2019-11-20 |
| 1558744748 | Ryan K Austin, Dds PC | Clinic/Center | 5742 S 1475 E Ste 100, South Ogden, UT 84403-4857 | 2015-07-07 |
| 1821400532 | Southwest Oral and Facial Surgery Inc | Clinic/Center | 11748 S 3600 W, Suite 1, South Jordan, UT 84095-5922 | 2014-05-29 |
| 1376827832 | Dustin J Hopkin Dds, Oral and Maxillofacial Surgery P.C. | Clinic/Center | 2180 E 4500 S Ste 285, Salt Lake City, UT 84117-4028 | 2011-10-03 |
| 1275722357 | Utah Surgical Arts | Clinic/Center | 3610 N University Ave, Suite 150, Provo, UT 84604-4437 | 2007-10-15 |
| City | FARMINGTON |
| Zip Code | 84025 |
Please comment or provide details below to improve the information on LEGACY HEIGHTS ORAL & FACIAL SURGERY PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.