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General NPI Number Information
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NPI Number | 1205454113
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Entity Type | Individual
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Provider Name | DYLAN LANE HARMON DMD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2020
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Last Update Date | 07/07/2020
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Provider Practice Location Address
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Address Line | 1445 N 400 E # 3A
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City | NORTH LOGAN
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State | UT
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Zip | 84341-7564
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Country | US
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Telephone | 435-363-3595
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Fax |
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Provider Business Mailing Address
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Address Line | 1750 N 1780 E
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City | NORTH LOGAN
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State | UT
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Zip | 84341-2192
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Country | US
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Telephone | 435-890-0379
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11769010-9922
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License Number State | UT
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