MEDICARE: RODNEY S GLEAVE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	145234-9922	UT

General Provider Information

NPI Number	:	1215002746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODNEY S GLEAVE DMD

Provider Business Mailing Address
First Line	:	622 EAST 4500 SOUTH
Second Line	:	SUITE #102
City	:	MURRAY
State	:	UT
Zip	:	84107
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 E 4500 SOUTH
Second Line	:	SUITE #102
City	:	MURRAY
State	:	UT
Zip	:	84107-2921
Country	:	US
Telephone Number	:	801-262-0744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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Directions to “ RODNEY S GLEAVE DMD” Practice Location

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