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General NPI Number Information
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NPI Number | 1598104853
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Entity Type | Individual
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Provider Name | BRANDON NORMAN GLENN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2013
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 2854 W 4700 S SUITE B
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City | TAYLORSVILLE
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State | UT
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Zip | 84129-2102
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Country | US
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Telephone | 801-432-7773
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Fax | 801-679-1958
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Provider Business Mailing Address
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Address Line | 2854 W 4700 S SUITE B
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City | TAYLORSVILLE
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State | UT
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Zip | 84129-2102
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Country | US
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Telephone | 801-432-7773
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Fax | 801-679-1958
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 10067031-9922
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 30.023962
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License Number State | OH
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