Organization
DENNIS L DEDECKER DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS L DEDECKER DDS (ORAL AND MAXILLOFACIAL SURGEON)
(801) 773-9790
Entity
Organization
Contact information
Practice address
2185 N 1700 W, #204, LAYTON, UT 84041-1192
(801) 773-9790
(801) 773-9792
Mailing address
2185 N 1700 W, #204, LAYTON, UT 84041-1192
(801) 773-9790
(801) 773-9792
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
135665 9924
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000002181
MEDICARE PROVIDER#
UT
01
—
107004925101
SELECTHEALTH
UT
01
—
190000851
RAILROAD MEDICARE
UT
01
—
52970991500001
BLUECROSS BLUESHIELD
UT
Enumeration date
01/02/2008
Last updated
06/15/2020
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