Provider Demographics
NPI:1336174077
Name:SPANGLER, GARY NELSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:NELSON
Last Name:SPANGLER
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 1:3453 STONE MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-6550
Mailing Address - Country:US
Mailing Address - Phone:801-943-7562
Mailing Address - Fax:
Practice Address - Street 1:7086 S HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:COTTONWOODS HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121
Practice Address - Country:US
Practice Address - Phone:801-942-5520
Practice Address - Fax:801-942-5594
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134453-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice