NPIMap

Organization Active NPI

Oral Surgery Specialty

  • Oral & Maxillofacial Surgery (D.M.D.)
  • South Jordan, UT
National Provider Identifier
1790089886
Registry record updated Nov 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
135181 Issued in UT
Legal business name
ORAL SURGERY SPECIALTY
Practice address
3648 W 9800 S
South Jordan, UT 84095-3260
Phone
(801) 397-2727
NPI assigned
Jan 4, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. L. Douglas Israelsen, DDS
Title
Owner
Phone
(801) 397-2727

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.)Group: 193400000X SINGLE SPECIALTY GROUP 204E00000X 135181 UT Primary

Addresses

Primary practice location

3648 W 9800 S
South Jordan, UT 84095-3260

Mailing address

PO Box 367
Draper, UT 84020-0367
Phone (801) 397-2727

National Provider Directory

National Provider Directory

Locations

3648 W 9800 S
South Jordan, UT 84009
Phone (801) 397-2727

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321920000000",
    "number": "1790089886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 367",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840200367",
            "telephone_number": "801-397-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3648 W 9800 S",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840953260",
            "telephone_number": "801-397-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL SURGERY SPECIALTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-04",
        "last_updated": "2011-11-22",
        "status": "A",
        "authorized_official_last_name": "ISRAELSEN",
        "authorized_official_first_name": "L.",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-397-2727",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "UT",
            "license": "135181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Jordan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.