Provider Demographics
NPI:1982012498
Name:DANCE, DALLIN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALLIN
Middle Name:J
Last Name:DANCE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7111 N. BERGSON DR.
Mailing Address - Street 2:
Mailing Address - City:COEURD'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815
Mailing Address - Country:US
Mailing Address - Phone:425-241-7554
Mailing Address - Fax:208-772-2213
Practice Address - Street 1:1027 W. PRAIRIE AVE.
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835
Practice Address - Country:US
Practice Address - Phone:208-772-2202
Practice Address - Fax:208-772-2213
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT907905799221223P0221X
IDD-4693-PD1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry