Provider Demographics
NPI:1225230535
Name:BILLS, GLEN CRAIG (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:CRAIG
Last Name:BILLS
Suffix:
Gender:M
Credentials:DMD, MS
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Mailing Address - Street 1:7555 CENTER VIEW CT
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-1970
Mailing Address - Country:US
Mailing Address - Phone:801-566-5681
Mailing Address - Fax:
Practice Address - Street 1:7555 CENTER VIEW CT
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-1970
Practice Address - Country:US
Practice Address - Phone:801-566-5681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT6414895-99211223X0400X
CA555091223X0400X
AZD71181223X0400X
IDD-3835-OR1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics