Provider Demographics
NPI:1164478681
Name:LOMBARDI, DENNIS L (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:L
Last Name:LOMBARDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-0276
Mailing Address - Country:US
Mailing Address - Phone:801-263-0810
Mailing Address - Fax:801-270-8170
Practice Address - Street 1:3460 PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2049
Practice Address - Country:US
Practice Address - Phone:801-263-0810
Practice Address - Fax:801-270-8170
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT154264-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQM0000076394OtherALTIUS
UT11-00008OtherUNITED HEALTH CARE
UT870327686013Medicaid
UTD87649Medicare UPIN