Provider Demographics
NPI:1437229275
Name:UTLEY, DAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:UTLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 E TABERNACLE
Mailing Address - Street 2:#1
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770
Mailing Address - Country:US
Mailing Address - Phone:435-628-9099
Mailing Address - Fax:435-673-3571
Practice Address - Street 1:444 E TABERNACLE
Practice Address - Street 2:#1
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-628-9099
Practice Address - Fax:435-673-3571
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8614309199221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
675686OtherUNITED CONCORDIA