Provider Demographics
NPI:1063763928
Name:NYE, DARLIECE (DMD)
Entity type:Individual
Prefix:DR
First Name:DARLIECE
Middle Name:
Last Name:NYE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14203 S FRIENDSHIP DR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-1880
Mailing Address - Country:US
Mailing Address - Phone:702-530-4240
Mailing Address - Fax:
Practice Address - Street 1:3798 S 700 E
Practice Address - Street 2:SUITE 6
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1150
Practice Address - Country:US
Practice Address - Phone:702-530-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV63661223G0001X
UT8449089-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice