Healthcare Provider Details

I. General information

NPI: 1922016245
Provider Name (Legal Business Name): GREGREY L MUSE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 S HIGHLAND DR STE 400
SALT LAKE CITY UT
84124
US

IV. Provider business mailing address

4460 S HIGHLAND DR STE 400
SALT LAKE CITY UT
84124
US

V. Phone/Fax

Practice location:
  • Phone: 801-272-4111
  • Fax: 801-272-5989
Mailing address:
  • Phone: 801-272-4111
  • Fax: 801-272-5989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1450769922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: