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Individual

DUSTIN JOHN FANCIULLO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1160 E 3900 S STE 3100, SALT LAKE CITY, UT 84124-1290
(801) 262-2806
Mailing address
PO BOX 281490, ATLANTA, GA 30384-1490

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
14267138-1205
UT
208600000X
Surgery Physician
252553
NY
2086S0129X
Vascular Surgery Physician
Primary
14267138-1205
UT
2086S0129X
Vascular Surgery Physician
Primary
252553-1
NY

Other

Enumeration date
08/21/2008
Last updated
03/02/2026
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