Healthcare Provider Details

I. General information

NPI: 1134504053
Provider Name (Legal Business Name): DALLIS JACOB ZURCHER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 E 4500 S STE 201
MURRAY UT
84107-2922
US

IV. Provider business mailing address

622 E 4500 S STE 201
MURRAY UT
84107-2922
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-8053
  • Fax:
Mailing address:
  • Phone: 801-268-8053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6635
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: