Provider Demographics
NPI:1043838840
Name:SANGER, JORDAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:SANGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 E MONARCH VIEW LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1273
Mailing Address - Country:US
Mailing Address - Phone:208-794-0468
Mailing Address - Fax:
Practice Address - Street 1:6770 S 900 E STE 301
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1761
Practice Address - Country:US
Practice Address - Phone:801-416-1599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11723611-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT11723611-8903OtherUTAH CONTROLLED SUBSTANCE LICENSE
UT11723611-9922OtherUTAH DENTAL LICENSE