Provider Demographics
NPI:1033497417
Name:CACHE VALLEY ORAL & FACIAL SURGERY, INC.
Entity type:Organization
Organization Name:CACHE VALLEY ORAL & FACIAL SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:435-752-5681
Mailing Address - Street 1:1320 N 600 E
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2431
Mailing Address - Country:US
Mailing Address - Phone:435-752-5681
Mailing Address - Fax:435-752-5744
Practice Address - Street 1:1320 N 600 E
Practice Address - Street 2:SUITE 3
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2431
Practice Address - Country:US
Practice Address - Phone:435-752-5681
Practice Address - Fax:435-752-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT795457999241223S0112X
UT13969099241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty