Provider Demographics
NPI:1770831430
Name:BANKS, BRIAN GLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:GLEN
Last Name:BANKS
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 1:2232 E 900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1404
Mailing Address - Country:US
Mailing Address - Phone:801-935-4422
Mailing Address - Fax:801-662-2390
Practice Address - Street 1:2500 S POWER RD STE 128
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209
Practice Address - Country:US
Practice Address - Phone:480-699-8082
Practice Address - Fax:480-588-5118
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8027359-99221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry