Provider Demographics
NPI:1457790180
Name:ALSTON, DYLAN BURNS (DO)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:BURNS
Last Name:ALSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 W 12600 S STE 270B
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7296
Mailing Address - Country:US
Mailing Address - Phone:801-285-4610
Mailing Address - Fax:801-285-4602
Practice Address - Street 1:3723 W 12600 S STE 270B
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065
Practice Address - Country:US
Practice Address - Phone:801-285-4610
Practice Address - Fax:801-285-4602
Is Sole Proprietor?:No
Enumeration Date:2013-06-15
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX577682207N00000X
UT10279690-1204207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology