Healthcare Provider Details

I. General information

NPI: 1063763928
Provider Name (Legal Business Name): DARLIECE NYE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3798 S 700 E SUITE 6
SALT LAKE CITY UT
84106-1150
US

IV. Provider business mailing address

14203 S FRIENDSHIP DR
HERRIMAN UT
84096-1880
US

V. Phone/Fax

Practice location:
  • Phone: 702-530-4240
  • Fax:
Mailing address:
  • Phone: 702-530-4240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8449089-9921
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6366
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: