Troy Dennis Dedecker, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6672756-9921 Issued in UT

Practice address

1480 South Orchard Drive
Suite 110
Bountiful, UT 84010-5142

Phone

(801) 295-9500

Fax

(801) 295-5512

NPI assigned

Feb 22, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203638400000",
    "number": "1265601314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1480 SOUTH ORCHARD DRIVE",
            "address_2": "SUITE 110",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840105142",
            "telephone_number": "801-295-9500",
            "fax_number": "801-295-5512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1480 SOUTH ORCHARD DRIVE",
            "address_2": "SUITE 110",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840105142",
            "telephone_number": "801-295-9500",
            "fax_number": "801-295-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEDECKER",
        "first_name": "TROY",
        "middle_name": "DENNIS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-02-22",
        "last_updated": "2008-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "6672756-9921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• DDMS of Utah No.2
• Jody E De Jonge, R.N.
• Michelle Nicole Dean, DPT
• Cayla Decocq
• Diedra Decorso
• Bradley J Deitch, D.M.D.
• Jacob Delamare
• Kort H. Delost, RPH
• Denali Medical Center
• Denali Specialty Clinic LLC

• General Practice Dentistry in Bountiful, UT
• Providers in Bountiful, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.