Healthcare Provider Details

I. General information

NPI: 1912965344
Provider Name (Legal Business Name): CHARLES F DAHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W 800 N STE 444
OREM UT
84057-6305
US

IV. Provider business mailing address

PO BOX 741729
ATLANTA GA
30374-1729
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-6412
  • Fax: 801-714-6412
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number1597521205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: