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General NPI Number Information
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NPI Number | 1457790180
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Entity Type | Individual
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Provider Name | DYLAN BURNS ALSTON DO
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Gender | Male
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Dates
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Enumeration Date | 06/15/2013
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 3723 W 12600 S STE 270B
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City | RIVERTON
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State | UT
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Zip | 84065
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Country | US
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Telephone | 801-285-4610
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Fax | 801-285-4602
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Provider Business Mailing Address
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Address Line | 3723 W 12600 S STE 270B
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City | RIVERTON
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State | UT
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Zip | 84065-7296
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Country | US
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Telephone | 801-285-4610
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Fax | 801-285-4602
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 577682
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 10279690-1204
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License Number State | UT
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