Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 335041-9921 | UT |
NPI | 1003812116 |
---|---|
Provider Name | Dr. Gary Anthony Carter |
First Address | Sandy, UT 84070-4156 |
Second Address | Sandy, UT 84070-4156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 11/11/2016 |