Individual
DEREK BURGOYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
11501 S 4000 W STE 101, SOUTH JORDAN, UT 84009-6028
(801) 701-2120
Mailing address
4508 W TEE BOX DR, SOUTH JORDAN, UT 84009-2785
(262) 364-7785
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14281827-9926
UT
Other
Enumeration date
04/22/2026
Last updated
04/22/2026
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