Provider Demographics
NPI:1841420056
Name:WOODWARD, BRANDON TYLER (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:TYLER
Last Name:WOODWARD
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 1:9829 S 1300 E STE 102
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-4065
Mailing Address - Country:US
Mailing Address - Phone:801-553-3562
Mailing Address - Fax:801-553-3564
Practice Address - Street 1:9829 S 1300 E STE 102
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-4065
Practice Address - Country:US
Practice Address - Phone:801-553-3562
Practice Address - Fax:801-553-3564
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7414783-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist