Individual
BRADLEY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
853 E 9400 S, SANDY, UT 84094-3655
(801) 572-5550
Mailing address
5327 W CANARY GRASS WAY, SOUTH JORDAN, UT 84009-1399
(801) 662-8371
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14228509-9926
UT
Other
Enumeration date
07/16/2025
Last updated
07/16/2025
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