Provider Demographics
NPI:1073516688
Name:DEDECKER, DENNIS (DDS, PC)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:DEDECKER
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 E 700 N TWIN CREEK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037
Mailing Address - Country:US
Mailing Address - Phone:801-544-2863
Mailing Address - Fax:
Practice Address - Street 1:2185 N 1700 W
Practice Address - Street 2:#204
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1154
Practice Address - Country:US
Practice Address - Phone:801-773-9790
Practice Address - Fax:801-773-9792
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13566599241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000058020OtherMEDICARE GROUP
UT35697OtherDMBA PROVIDER #
UT43-00008OtherUNITEDHEALTH CARE (UHC) #
UT64163OtherPUBLIC EMPLOYEES (PEHP) #
UT107004925101OtherSELECTHEALTH #
UT190000851OtherRAILROAD MEDICARE #
UT190644OtherUNITED CONCORDIA #
UT870344080DE1OtherEDUCATORS MUTUAL #
UT35697OtherDMBA PROVIDER #
UT43-00008OtherUNITEDHEALTH CARE (UHC) #