Provider Demographics
NPI:1912977752
Name:GATRELL, GREGORY WALLACE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WALLACE
Last Name:GATRELL
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 1:2015 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3658
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:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-3658
Practice Address - Country:US
Practice Address - Phone:801-485-5952
Practice Address - Fax:801-485-5965
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5927403-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT$$$$$$$$$001Medicaid