DR. GARY L WILSON (NPI# 1164589743) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164589743 |
| Entity Type | Individual |
| Full Name | DR. GARY L WILSON |
| Credential | D.M.D. |
| Practice Address |
1355 N University Ave Ste 310 Provo UT 84604-2721 |
| Practice Telephone | 8013704040 |
| Mailing Telephone | 8013704040 |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
276251-9922 | UT | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881079572 | Gary Wilson | Chiropractor | 23701 Carlson Ct, Hayward, CA 94541-4592 | 2015-07-23 |
| 1447581269 | Gary Trent Wilson Jr. | Dentist | 6250 Poplar Ave, Memphis, TN 38119-4713 | 2010-01-18 |
| 1518953603 | Gary M Wilson | Social Worker | 304 W Will Rogers Blvd, Claremore, OK 74017-7022 | 2005-09-23 |
| 1285635946 | Gary Alan Wilson | Dentist | Highway 264, Milepost 388, Polacca, AZ 86042-6042 | 2005-08-03 |
| 1215933056 | Gary A Wilson | Surgery | 311 N Clyde Morris Blvd, Daytona Beach, FL 32114-2781 | 2005-06-27 |
| 1386261220 | Gary Anthony Wilson | Counselor | 4300 Sw 13th St, Gainesville, FL 32608-4006 | 2020-06-26 |
| 1962844522 | Gary Mark Wilson | Nurse Practitioner | 1301 1st St, Kennett, MO 63857-2525 | 2013-07-24 |
| 1972882660 | Gary A Wilson | Case Manager/Care Coordinator | 1909 Commerce Ave, Cullman, AL 35055-6151 | 2011-08-11 |
| 1578708137 | Gary K Wilson | Physical Therapist | 3195 Calder St, Ste 201, Beaumont, TX 77702-1425 | 2008-12-11 |
| 1225257355 | Gary Wilson | Dentist | 715 W Wheatland Rd, Duncanville, TX 75116-4520 | 2007-04-25 |
| Street Address |
1355 N UNIVERSITY AVE STE 310 |
| City | PROVO |
| State | UT |
| Zip Code | 84604-2721 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669031845 | Dane Troy Goodwin | Dentist | 1355 N University Ave Ste 310, Provo, UT 84604-2721 | 2019-06-11 |
| 1063923258 | Provo Family Dentistry, LLC | Clinic/Center | 1355 N University Ave Ste 310, Provo, UT 84604-2721 | 2017-10-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346882107 | Abigail Belle Hardy | Student in an Organized Health Care Education/Training Program | 1190 900 E, Provo, UT 84604 | 2019-10-14 |
| 1386106698 | Sarah Roseman Hunt | Nurse Practitioner | 1055 N 500 W., Suite. 101, Bldg. C, Provo, UT 84604 | 2019-04-04 |
| 1255813325 | Hwigeum Jeong | Specialist/Technologist | Department of Exercise Sciences 106 Sfh Brigham Young, Provo, UT 84604 | 2018-09-05 |
| 1093203044 | Snowcap Smile Studio LLC | Dentist | 2230 N. University Pkwy Ste 8b, Provo, UT 84604 | 2018-04-25 |
| 1407359078 | Ihc Health Services Inc | Clinic/Center | 380 W Bulldog Blvd, Ste 403, Provo, UT 84604 | 2018-03-09 |
| 1902308455 | Afton Leuga | Nurse Practitioner | 395 W Bulldog Blvd., Suite 401, Provo, UT 84604 | 2018-03-01 |
| 1851807333 | Ihc Health Services Inc | Family Medicine | 380 W 1230 N, Ste 602, Provo, UT 84604 | 2017-12-20 |
| 1689180218 | Ihc Health Services Inc | Pediatrics | 395 W Bulldog Blvd Ste 703, Provo, UT 84604 | 2017-12-19 |
| 1396254165 | Nicolas Sorensen | Massage Therapist | 247 West 2230 North #201, Provo, UT 84604 | 2017-09-25 |
| 1437692241 | Cirque Lodge Inc | Substance Abuse Rehabilitation Facility | 3114 E Ida's Road, Sundance, UT 84604 | 2016-11-28 |
| Find all providers in zip 84604 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013574870 | Tanner Gardner Perry | Dentist | 320 River Park Dr Ste 225, Provo, UT 84604-6065 | 2019-05-28 |
| 1003206350 | Blue Mountain Family Dental | Dentist | 1675 N 200 W #8a, Provo, UT 84604 | 2015-01-26 |
| 1215342282 | Jay D Scott Dds PC | Dentist | 3330 N University Ave Ste A, Provo, UT 84604-4454 | 2014-06-27 |
| 1780939348 | Todd Clinton Groesbeck | Dentist | 247 W 2230 N Ste 101, Provo, UT 84604-7582 | 2012-07-19 |
| 1083978316 | Heath Hendrickson Mbr | Dentist | 2230 N University Pkwy Ste 8a, Provo, UT 84604-6702 | 2012-07-02 |
| 1639472665 | Gregory William Sefcik | Dentist | 1383 W 1825 N, Provo, UT 84604-1125 | 2010-12-14 |
| 1093043143 | Chris Hammond | Dentist | 3575 N 100 E Ste 200, Provo, UT 84604-6653 | 2009-12-01 |
| 1043440357 | Paul Henry Rogers | Dentist | 777 N. 500 W., #201, Provo, UT 84601 | 2009-07-21 |
| 1336309640 | Owen E Wolfgramm | Dentist | 2476 N University Pkwy Ste 101, Provo, UT 84604-3801 | 2008-06-10 |
| 1013111277 | Robert L. Hamblin, D.d.s. | Dentist | 3200 N Canyon Rd Ste F, Provo, UT 84604-4571 | 2007-06-12 |
| Find all providers in PROVO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.