Healthcare Provider Details

I. General information

NPI: 1366842981
Provider Name (Legal Business Name): DALLIN PALMER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N MAIN ST
MAPLETON UT
84664-3410
US

IV. Provider business mailing address

1843 E 160 S
SPANISH FORK UT
84660-5587
US

V. Phone/Fax

Practice location:
  • Phone: 801-491-8191
  • Fax: 801-491-8191
Mailing address:
  • Phone: 801-634-1996
  • Fax: 801-634-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30182
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9461687
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: