Healthcare Provider Details

I. General information

NPI: 1114912854
Provider Name (Legal Business Name): NATHAN ALEXANDER DINSBACH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 S REDWOOD RD STE C
WEST JORDAN UT
84084-3479
US

IV. Provider business mailing address

3773 W 1330 N
LEHI UT
84043-7378
US

V. Phone/Fax

Practice location:
  • Phone: 801-304-1111
  • Fax:
Mailing address:
  • Phone: 801-558-0973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5719272-9923
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: