Provider Demographics
NPI:1457918500
Name:CORDNER, GRANT GUY (DMD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:GUY
Last Name:CORDNER
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 1:425 W 1420 S
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-8669
Mailing Address - Country:US
Mailing Address - Phone:480-390-7904
Mailing Address - Fax:
Practice Address - Street 1:425 W 1420 S
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-8669
Practice Address - Country:US
Practice Address - Phone:480-390-7904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11286066-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice