Healthcare Provider Details

I. General information

NPI: 1104974161
Provider Name (Legal Business Name): GARY A. CARTER, D.D.S., M.S., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6052 S STATE ST SUITE 7
MURRAY UT
84107-7225
US

IV. Provider business mailing address

6052 S STATE ST SUITE 7
MURRAY UT
84107-7225
US

V. Phone/Fax

Practice location:
  • Phone: 801-288-9100
  • Fax:
Mailing address:
  • Phone: 801-288-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number335041-9921
License Number StateUT

VIII. Authorized Official

Name: DR. GARY ANTHONY CARTER
Title or Position: ORTHODONTIST
Credential: D.D.S., M.S.
Phone: 801-288-9100