Healthcare Provider Details

I. General information

NPI: 1003812116
Provider Name (Legal Business Name): GARY ANTHONY CARTER D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 S 4000 W STE B
WEST VALLEY CITY UT
84120-6250
US

IV. Provider business mailing address

12207 S WIGWAM LN
DRAPER UT
84020-8855
US

V. Phone/Fax

Practice location:
  • Phone: 801-955-1900
  • Fax:
Mailing address:
  • Phone: 385-445-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number335041-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: