Individual
DENNIS DEDECKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, PC
Contact information
Practice address
2185 N 1700 W, #204, LAYTON, UT 84041-1154
(801) 773-9790
(801) 773-9792
Mailing address
447 E 700 N TWIN CREEK CIRCLE, KAYSVILLE, UT 84037
(801) 544-2863
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
1356659924
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000058020
MEDICARE GROUP
UT
01
—
107004925101
SELECTHEALTH #
UT
01
—
190000851
RAILROAD MEDICARE #
UT
01
—
190644
UNITED CONCORDIA #
UT
01
—
35697
DMBA PROVIDER #
UT
01
—
43-00008
UNITEDHEALTH CARE (UHC) #
UT
01
—
64163
PUBLIC EMPLOYEES (PEHP) #
UT
01
—
870344080DE1
EDUCATORS MUTUAL #
UT
Enumeration date
05/27/2005
Last updated
04/05/2011
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