Organization
KIDZ DENTAL WORKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY SCOTT WALL DDS (OWNER)
(801) 776-8176
Entity
Organization
Contact information
Practice address
780 S 2000 W, BLDG F2, SYRACUSE, UT 84075
(801) 776-8176
(801) 774-9085
Mailing address
780 S 2000 W, BLDG F2, SYRACUSE, UT 84075
(801) 776-8176
(801) 774-9085
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
266402
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528902470008
—
UT
Enumeration date
02/20/2007
Last updated
07/14/2008
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