Individual
GARY WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
780 S 2000 W STE F2, SYRACUSE, UT 84075-9609
(801) 776-8176
Mailing address
780 S 2000 W STE F2, SYRACUSE, UT 84075-9609
(801) 776-8176
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
266402
UT
Other
Enumeration date
09/10/2015
Last updated
09/10/2015
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