MEDICARE: DR. GREGORY WALLACE GATRELL D.D.S.

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	1223G0001X	General Practice Dentistry	5927403-9923	UT

General Provider Information

NPI Number	:	1912977752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY WALLACE GATRELL D.D.S.

Provider Business Mailing Address
First Line	:	2015 S 1300 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3658
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	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3658
Country	:	US
Telephone Number	:	801-485-5952
Fax Number	:	801-485-5965

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	01/09/2023

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