Provider Demographics
NPI:1639384209
Name:WRIGHT, GARTH JEREL (DDS)
Entity type:Individual
Prefix:
First Name:GARTH
Middle Name:JEREL
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JEREL
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:715 E 3900 S
Mailing Address - Street 2:#103
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2182
Mailing Address - Country:US
Mailing Address - Phone:801-266-4701
Mailing Address - Fax:801-269-0627
Practice Address - Street 1:715 E 3900 S
Practice Address - Street 2:#103
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2182
Practice Address - Country:US
Practice Address - Phone:801-266-4701
Practice Address - Fax:801-269-0627
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1413011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice