Provider Demographics
NPI:1659543387
Name:MINNOCH, J BRENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:BRENT
Last Name:MINNOCH
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 1:460 S 400 E
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4975
Mailing Address - Country:US
Mailing Address - Phone:801-295-5586
Mailing Address - Fax:801-292-5342
Practice Address - Street 1:460 S 400 E
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4975
Practice Address - Country:US
Practice Address - Phone:801-295-5586
Practice Address - Fax:801-292-5342
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13029999221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice