Healthcare Provider Details

I. General information

NPI: 1881035749
Provider Name (Legal Business Name): DYLAN N DO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 S AUBURN ST STE 6
GRASS VALLEY CA
95945-7298
US

IV. Provider business mailing address

PO BOX 20043
FOUNTAIN VALLEY CA
92728-0043
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-5522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number64381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: