Provider Demographics
NPI:1386224467
Name:G W GATRELL DDS PC
Entity type:Organization
Organization Name:G W GATRELL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:GATRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-386-6729
Mailing Address - Street 1:2015 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3613
Mailing Address - Country:US
Mailing Address - Phone:801-485-5952
Mailing Address - Fax:801-485-5965
Practice Address - Street 1:2015 S 1300 E
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84105-3613
Practice Address - Country:US
Practice Address - Phone:801-485-5952
Practice Address - Fax:801-485-5965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental