LAKESIDE ORAL & MAXILLOFACIAL SURGERY NPI 1417898560

NPI Information

  • NPI: 1417898560
  • Provider Name: LAKESIDE ORAL & MAXILLOFACIAL SURGERY
  • Classification: Clinic/Center - 261QS0112X
  • Specialization: Oral and Maxillofacial Surgery
  • Entity Type: Organization
  • Address: 1528 N COMMERCE DR STE 203
    SARATOGA SPRINGS, UT
    ZIP 84045
  • Phone: (801) 224-1200

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NPI Details

LAKESIDE ORAL & MAXILLOFACIAL SURGERY is an oral and maxillofacial surgery clinic center in Saratoga Springs, UT. The provider is an oral and maxillofacial surgery clinic or center specialized in 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. LAKESIDE ORAL & MAXILLOFACIAL SURGERY NPI is 1417898560. The provider is registered as an organization entity type.

The provider's business location address is:

1528 N COMMERCE DR STE 203
SARATOGA SPRINGS, UT
ZIP 84045-031
Phone: (801) 224-1200

The provider's authorized official is Jared E. Rasmussen .
The authorized official title is Owner and has the following contact phone number (972) 977-6587.

The enumeration date for this NPI number is 4/2/2026 and was last updated on 4/2/2026.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QS0112XClinic/CenterOral and Maxillofacial SurgeryYes

What is NPI?

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This page was last updated on: 11/21/2025

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