Provider Demographics
NPI:1750473435
Name:DYER, BRICANEI A (DDS)
Entity type:Individual
Prefix:DR
First Name:BRICANEI
Middle Name:A
Last Name:DYER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 S BLUFF ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5236
Mailing Address - Country:US
Mailing Address - Phone:435-628-8885
Mailing Address - Fax:435-656-3008
Practice Address - Street 1:1150 S BLUFF ST STE 1
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5236
Practice Address - Country:US
Practice Address - Phone:435-628-8885
Practice Address - Fax:435-656-3008
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT036276531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice