Provider Demographics
NPI:1457563405
Name:DURRANT, STANFORD HAMMOND (DMD)
Entity Type:Individual
Prefix:DR
First Name:STANFORD
Middle Name:HAMMOND
Last Name:DURRANT
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 1:1770 FORT UNION BLVD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2876
Mailing Address - Country:US
Mailing Address - Phone:801-942-1400
Mailing Address - Fax:801-943-1951
Practice Address - Street 1:1770 FORT UNION BLVD
Practice Address - Street 2:SUITE #200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-2876
Practice Address - Country:US
Practice Address - Phone:801-942-1400
Practice Address - Fax:801-943-1951
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1428431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice