Provider Demographics
NPI:1528251105
Name:DICKERSON, DARIN ARTHUR (DMD)
Entity type:Individual
Prefix:DR
First Name:DARIN
Middle Name:ARTHUR
Last Name:DICKERSON
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 1:4888 S HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117
Mailing Address - Country:US
Mailing Address - Phone:801-277-9213
Mailing Address - Fax:801-277-0956
Practice Address - Street 1:4888 S HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-6007
Practice Address - Country:US
Practice Address - Phone:801-277-9213
Practice Address - Fax:801-277-0956
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ60271223G0001X
UT5121811-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice