Provider Demographics
NPI:1467478883
Name:BEYELER, GREG T (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:T
Last Name:BEYELER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2936 HIGHLAND DR
Mailing Address - Street 2:STE 200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3582
Mailing Address - Country:US
Mailing Address - Phone:801-485-8888
Mailing Address - Fax:801-485-8188
Practice Address - Street 1:2936 HIGHLAND DR
Practice Address - Street 2:STE 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3582
Practice Address - Country:US
Practice Address - Phone:801-485-8888
Practice Address - Fax:801-485-8188
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT144710-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice