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General NPI Number Information
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NPI Number | 1578748190
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Entity Type | Organization
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Legal Business Name | DENNIS L DEDECKER DDS PC
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 2185 N 1700 W #204
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City | LAYTON
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State | UT
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Zip | 84041-1192
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Country | US
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Telephone | 801-773-9790
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Fax | 801-773-9792
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Provider Business Mailing Address
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Address Line | 2185 N 1700 W #204
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City | LAYTON
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State | UT
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Zip | 84041-1192
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Country | US
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Telephone | 801-773-9790
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Fax | 801-773-9792
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Authorized Official
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Title or Position | ORAL AND MAXILLOFACIAL SURGEON
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Name | DENNIS L DEDECKER
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Credential | DDS
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Telephone | 801-773-9790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 135665 9924
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License Number State | UT
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