Provider Demographics
NPI:1588324479
Name:DEWEY, DALLON JAY
Entity type:Individual
Prefix:
First Name:DALLON
Middle Name:JAY
Last Name:DEWEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82
Mailing Address - Street 2:
Mailing Address - City:FORT WASHAKIE
Mailing Address - State:WY
Mailing Address - Zip Code:82514-0082
Mailing Address - Country:US
Mailing Address - Phone:307-349-5648
Mailing Address - Fax:
Practice Address - Street 1:1424 17 MILE RD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-8600
Practice Address - Country:US
Practice Address - Phone:307-851-5408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator