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General NPI Number Information
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NPI Number | 1659032431
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Entity Type | Individual
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Provider Name | SPENCER C DYKMAN DDS
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Gender | Male
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 375 N MAIN ST STE 204
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City | KAYSVILLE
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State | UT
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Zip | 84037-1278
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Country | US
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Telephone | 385-786-9652
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Fax |
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Provider Business Mailing Address
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Address Line | 3352 W 625 S
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City | SYRACUSE
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State | UT
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Zip | 84075-8070
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Country | US
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Telephone | 208-608-8252
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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 | 13965903-9926
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 13965903-9926
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2021018860
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License Number State | MO
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