MEDICARE: G W GATRELL DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1386224467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G W GATRELL DDS PC

Provider Business Mailing Address
First Line	:	2015 S 1300 E
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84105-3613
Country	:	US
Telephone Number	:	801-485-5952
Fax Number	:	801-485-5965

Provider Business Practice Location Address
First Line	:	2015 S 1300 E
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84105-3613
Country	:	US
Telephone Number	:	801-485-5952
Fax Number	:	801-485-5965

Authorized Official
Title or Position	:	CORPORATION SECRETARY
Name	:	ALYSSA ELLEN GATRELL
Credential	:
Telephone Number	:	801-386-6729

Provider Enumeration Date	:	04/12/2021
Last Update Date	:	04/12/2021

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