Provider Demographics
NPI:1922075274
Name:DAL CANTO, ALBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:J
Last Name:DAL CANTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-501-2100
Mailing Address - Fax:801-501-2107
Practice Address - Street 1:9450 S 1300 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-5555
Practice Address - Country:US
Practice Address - Phone:801-501-6250
Practice Address - Fax:801-501-6260
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6554164-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000063204Medicare PIN
WVDA6033181Medicare ID - Type Unspecified
WV3810002334Medicaid
I32343Medicare UPIN
UT2547141OtherUNITED HEALTH CARE