Individual
LARELL C. VAN DYKE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
610 LOADER DR, PLEASANT GROVE, UT 84062-3116
(801) 785-7024
Mailing address
PO BOX 1079, PLEASANT GROVE, UT 84062-1079
(801) 785-7024
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
133101-9921
UT
Other
Enumeration date
06/15/2006
Last updated
07/08/2007
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