Provider Demographics
NPI:1265566624
Name:SONNENBERG, BRENT C (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:C
Last Name:SONNENBERG
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8941 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2400
Mailing Address - Country:US
Mailing Address - Phone:801-256-3636
Mailing Address - Fax:801-256-3633
Practice Address - Street 1:8941 S 700 E
Practice Address - Street 2:SUITE 201
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2420
Practice Address - Country:US
Practice Address - Phone:801-256-3636
Practice Address - Fax:801-256-3633
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1388481223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics