Provider Demographics
NPI:1427408988
Name:DELOACH, DENNIS DALLIN (DMD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:DALLIN
Last Name:DELOACH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 N 490 E
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:UT
Mailing Address - Zip Code:84624-9101
Mailing Address - Country:US
Mailing Address - Phone:801-834-3011
Mailing Address - Fax:
Practice Address - Street 1:60 S 300 E
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:UT
Practice Address - Zip Code:84624-5551
Practice Address - Country:US
Practice Address - Phone:435-864-5195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9826721-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist