Provider Demographics
NPI:1992809339
Name:SANDS, GLENN L (DDS)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:L
Last Name:SANDS
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 1:1770 E FT UNION BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2878
Mailing Address - Country:US
Mailing Address - Phone:801-733-4049
Mailing Address - Fax:
Practice Address - Street 1:1770 FORT UNION BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-2878
Practice Address - Country:US
Practice Address - Phone:801-942-0610
Practice Address - Fax:801-942-0706
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000110341223G0001X
UT91-1452679922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice