Provider Demographics
NPI:1659862555
Name:SMUIN, DALLAS MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:MICHAEL
Last Name:SMUIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 300 N
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-2351
Mailing Address - Country:US
Mailing Address - Phone:435-722-4691
Mailing Address - Fax:435-722-9291
Practice Address - Street 1:250 W 300 N
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-2351
Practice Address - Country:US
Practice Address - Phone:435-722-4691
Practice Address - Fax:435-722-9291
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT215025207X00000X
PAMD471072207X00000X
NMMD2023-0551207X00000X
UT8101734-1205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery