Provider Demographics
NPI:1649966623
Name:THUESON, DALLIN HATHAWAY (DDS)
Entity type:Individual
Prefix:MR
First Name:DALLIN
Middle Name:HATHAWAY
Last Name:THUESON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N 1600 W
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-3103
Mailing Address - Country:US
Mailing Address - Phone:208-206-8402
Mailing Address - Fax:801-491-6044
Practice Address - Street 1:108 N 1600 W
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:UT
Practice Address - Zip Code:84664
Practice Address - Country:US
Practice Address - Phone:801-491-6844
Practice Address - Fax:801-491-6044
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13908631-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice