MEDICARE: MICHAEL A GLADWELL D.M.D., MD

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	D12291	MN
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	347697-9924	UT
3	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	54113	MN
4	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	347697-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639250673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A GLADWELL D.M.D., MD

Provider Business Mailing Address
First Line	:	1250 E 3900 S STE 360
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1362
Country	:	US
Telephone Number	:	801-262-7447
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 E 3900 S STE 360
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1362
Country	:	US
Telephone Number	:	801-262-7447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	11/12/2024

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