Provider Demographics
NPI:1972794030
Name:LIGHTHALL, DIRK MURDOCK (DDS)
Entity type:Individual
Prefix:
First Name:DIRK
Middle Name:MURDOCK
Last Name:LIGHTHALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2797 N HIGHWAY 89 STE 201
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84404-1231
Mailing Address - Country:US
Mailing Address - Phone:801-737-2410
Mailing Address - Fax:
Practice Address - Street 1:2797 N HWY 89 STE 201
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84404-1231
Practice Address - Country:US
Practice Address - Phone:801-737-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD075331223G0001X
UT6592134-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice