Dr. Gary Lynn Ellis
Oral and Maxillofacial Pathology
500 Chipeta Way
Salt Lake City
, Utah 84108-1221
Dr. Gary Lynn Ellis
Oral and Maxillofacial Pathology
500 Chipeta Way
Salt Lake City
, Utah 84108-1221
(801) 584-5255
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About
Features
Specialties
- Oral and Maxillofacial Pathology
Languages spoken
- English
Location
First Address
- Dr. Gary Lynn Ellis
- 500 Chipeta Way
- Salt Lake City, UT
- Zip : 84108-1221
- Fax : (801) 584-5255
- Phone : (801) 583-2787
Second Address
- Dr. Gary Lynn Ellis
- 500 Chipeta Way
- Salt Lake City, UT
- Zip : 84108-1221
- Fax : (801) 584-5255
- Phone : (801) 583-2787
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223P0106X | Oral and Maxillofacial Pathology | 5129775-9921 | UT |
National Provider Identifier
| NPI | 1700840717 |
|---|---|
| Provider Name | Dr. Gary Lynn Ellis |
| First Address | Salt Lake City, UT 84108-1221 |
| Second Address | Salt Lake City, UT 84108-1221 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 14/04/2006 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 5129775-9921 | DENTAL LICENSE (01) | UT |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.