Individual
DR. JOHN ROBERT GERVASI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1834 S STATE ST, OREM, UT 84097-8109
(801) 302-2600
Mailing address
1248 E SOPHOMORE CIR, SALT LAKE CITY, UT 84117-4161
(440) 533-5775
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12773533-9922
UT
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/11/2021
Last updated
07/26/2022
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