Provider Demographics
NPI:1922666049
Name:DYNASTY DIAGNOSTICS
Entity Type:Organization
Organization Name:DYNASTY DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-842-8987
Mailing Address - Street 1:4616 S BEEHIVE DR APT 3
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-1806
Mailing Address - Country:US
Mailing Address - Phone:435-900-3390
Mailing Address - Fax:
Practice Address - Street 1:4616 S BEEHIVE DR APT 3
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-1806
Practice Address - Country:US
Practice Address - Phone:435-900-3390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory