Individual
DR. GRANT GUY CORDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
72 S 1ST E STE 102, REXBURG, ID 83440-1902
(208) 356-4900
(208) 359-1600
Mailing address
PO BOX 18, SAINT ANTHONY, ID 83445-0018
(208) 356-4900
(208) 624-4112
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11286066-9922
UT
1223G0001X
General Practice Dentistry
Primary
D-5436
ID
Other
Enumeration date
05/23/2019
Last updated
04/21/2026
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