Larell C. Van Dyke, D.D.S. Valid NPI

Individual provider · General Practice Dentistry · Pleasant Grove, UT

NPI

1114961620

Type

Individual (Type 1)

Primary specialty

General Practice Dentistry (Dentist)

Specialty group

Dental Providers

Taxonomy code

1223G0001X

License number

133101-9921 (UT)

Sex

Male

Sole proprietor

No

Enumerated

2006-06-15

Last updated

2007-07-08