Provider Demographics
NPI:1598104853
Name:GLENN, BRANDON NORMAN (DDS)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:NORMAN
Last Name:GLENN
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 1:2854 W 4700 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-2102
Mailing Address - Country:US
Mailing Address - Phone:801-432-7773
Mailing Address - Fax:801-679-1958
Practice Address - Street 1:2854 W 4700 S
Practice Address - Street 2:SUITE B
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-2102
Practice Address - Country:US
Practice Address - Phone:801-432-7773
Practice Address - Fax:801-679-1958
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10067031-99221223E0200X
OH30.0239621223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics