Provider Demographics
NPI:1881860229
Name:HARSTON, DENNIS TUCKER (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:TUCKER
Last Name:HARSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10421 S JORDAN GTWY STE 400
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3918
Mailing Address - Country:US
Mailing Address - Phone:801-933-3522
Mailing Address - Fax:801-933-3017
Practice Address - Street 1:10421 S JORDAN GTWY STE 400
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3918
Practice Address - Country:US
Practice Address - Phone:801-933-3522
Practice Address - Fax:801-933-3017
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1604401205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine