Healthcare Provider Details

I. General information

NPI: 1013160597
Provider Name (Legal Business Name): MELANIE ANN DANCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E 3900 S
SALT LAKE CITY UT
84124-1348
US

IV. Provider business mailing address

3445 E 3020 S
SALT LAKE CITY UT
84109-4219
US

V. Phone/Fax

Practice location:
  • Phone: 801-265-2000
  • Fax:
Mailing address:
  • Phone: 801-581-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7152053-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number7152053-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: