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General NPI Number Information
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NPI Number | 1922666049
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Entity Type | Organization
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Legal Business Name | DYNASTY DIAGNOSTICS
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 1572 S DIXIE DR STE 106
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City | SAINT GEORGE
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State | UT
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Zip | 84770-5820
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Country | US
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Telephone | 435-900-3390
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Fax |
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Provider Business Mailing Address
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Address Line | 1572 S DIXIE DR STE 106
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City | SAINT GEORGE
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State | UT
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Zip | 84770-5820
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Country | US
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Telephone | 435-900-3390
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MR. ADAM LAW
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Credential |
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Telephone | 509-842-8987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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