Provider Demographics
NPI:1578901674
Name:GREENWOOD, BRYAN GLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:GLEN
Last Name:GREENWOOD
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 1:76 E COMMERCE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-4022
Mailing Address - Country:US
Mailing Address - Phone:801-766-3269
Mailing Address - Fax:801-766-3272
Practice Address - Street 1:76 E COMMERCE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-4022
Practice Address - Country:US
Practice Address - Phone:801-766-3269
Practice Address - Fax:801-766-3272
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8669892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist