Active NPI
Dennis Dedecker, DDS, PC
- Oral and Maxillofacial Surgery (Dentist)
- Layton, UT
National Provider Identifier
1073516688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 1356659924
- Practice address
- 2185 N 1700 W
#204
Layton, UT 84041-1154 - Phone
- (801) 773-9790
- Fax
- (801) 773-9792
- NPI assigned
- May 27, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 1356659924 | UT | Primary |
Addresses
Primary practice location
2185 N 1700 W
#204
Layton, UT 84041-1154
Mailing address
447 E 700 N Twin Creek Circle
Kaysville, UT 84037
Phone (801) 544-2863
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000058020 | Other | UT | MEDICARE GROUP |
| 35697 | Other | UT | DMBA PROVIDER # |
| 43-00008 | Other | UT | UNITEDHEALTH CARE (UHC) # |
| 64163 | Other | UT | PUBLIC EMPLOYEES (PEHP) # |
| 107004925101 | Other | UT | SELECTHEALTH # |
| 190000851 | Other | UT | RAILROAD MEDICARE # |
| 190644 | Other | UT | UNITED CONCORDIA # |
| 870344080DE1 | Other | UT | EDUCATORS MUTUAL # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1356659924 | UT | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301961600000",
"number": "1073516688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "447 E 700 N TWIN CREEK CIRCLE",
"city": "KAYSVILLE",
"state": "UT",
"postal_code": "84037",
"telephone_number": "801-544-2863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2185 N 1700 W",
"address_2": "#204",
"city": "LAYTON",
"state": "UT",
"postal_code": "840411154",
"telephone_number": "801-773-9790",
"fax_number": "801-773-9792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDECKER",
"first_name": "DENNIS",
"credential": "DDS, PC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-05-27",
"last_updated": "2011-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "UT",
"license": "1356659924",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP",
"identifier": "000058020",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMBA PROVIDER #",
"identifier": "35697",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITEDHEALTH CARE (UHC) #",
"identifier": "43-00008",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PUBLIC EMPLOYEES (PEHP) #",
"identifier": "64163",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SELECTHEALTH #",
"identifier": "107004925101",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE #",
"identifier": "190000851",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA #",
"identifier": "190644",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EDUCATORS MUTUAL #",
"identifier": "870344080DE1",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Layton, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.