Individual
GAVIN TREVOR SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
60 E STATE RD, PLEASANT GROVE, UT 84062-2637
(801) 785-2574
Mailing address
60 E STATE RD, PLEASANT GROVE, UT 84062-2637
(801) 785-2574
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3420469922
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3420469922
STATE LICENSE
UT
Enumeration date
05/16/2007
Last updated
07/08/2007
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