MEDICARE: DR. DALLIS JACOB ZURCHER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	6635	NV

General Provider Information

NPI Number	:	1134504053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALLIS JACOB ZURCHER DDS

Provider Business Mailing Address
First Line	:	622 E 4500 S STE 201
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-2922
Country	:	US
Telephone Number	:	801-268-8053
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 E 4500 S STE 201
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-2922
Country	:	US
Telephone Number	:	801-268-8053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	05/11/2021

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