Healthcare Provider Details

I. General information

NPI: 1689722811
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: 01/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W SEGO LILY DR #106
SANDY UT
84070-3299
US

IV. Provider business mailing address

12207 WIGWAM LN
DRAPER UT
84020-8855
US

V. Phone/Fax

Practice location:
  • Phone: 801-255-9000
  • Fax:
Mailing address:
  • Phone: 801-495-1876
  • 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: 801-255-9000