Individual
MICHAEL A GLADWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D., MD
Contact information
Practice address
1250 E 3900 S STE 360, SALT LAKE CITY, UT 84124-1362
(801) 262-7447
Mailing address
1250 E 3900 S STE 360, SALT LAKE CITY, UT 84124-1362
(801) 262-7447
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
347697-1205
UT
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
347697-9924
UT
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
54113
MN
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
D12291
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33828100
—
WI
05
—
935190000
—
MN
05
—
ENROLLED
—
MN
Enumeration date
10/18/2006
Last updated
11/12/2024
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