Individual
DR. DEREK J DUTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
90 HOPE DR, MOUNTAIN HOME AFB, ID 83648
(208) 828-7300
Mailing address
745 SW PANNER ST, MOUNTAIN HOME, ID 83647-6463
(435) 864-7168
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
10337490-9922
UT
1223G0001X
General Practice Dentistry
Primary
10337490-9922
UT
Other
Enumeration date
05/11/2017
Last updated
08/27/2018
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