Provider Demographics
NPI:1215002746
Name:GLEAVE, RODNEY S (DMD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:S
Last Name:GLEAVE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 EAST 4500 SOUTH
Mailing Address - Street 2:SUITE #102
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:622 E 4500 SOUTH
Practice Address - Street 2:SUITE #102
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-2921
Practice Address - Country:US
Practice Address - Phone:801-262-0744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT145234-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice