Provider Demographics
NPI:1508442948
Name:DEMILLE, JOHN COLLIN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:COLLIN
Last Name:DEMILLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTAQUIN
Mailing Address - State:UT
Mailing Address - Zip Code:84655-7267
Mailing Address - Country:US
Mailing Address - Phone:801-658-0221
Mailing Address - Fax:
Practice Address - Street 1:451 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTAQUIN
Practice Address - State:UT
Practice Address - Zip Code:84655-7267
Practice Address - Country:US
Practice Address - Phone:801-658-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT81825991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice