Provider Demographics
NPI:1013208230
Name:MERYS DOWNER-GARNETTE, DMD, PA
Entity Type:Organization
Organization Name:MERYS DOWNER-GARNETTE, DMD, PA
Other - Org Name:SMILE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MERYS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOWNER-GARNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-951-5749
Mailing Address - Street 1:315 N LAKEMONT AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3205
Mailing Address - Country:US
Mailing Address - Phone:407-951-5749
Mailing Address - Fax:407-951-5765
Practice Address - Street 1:315 N LAKEMONT AVE
Practice Address - Street 2:SUITE D
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3205
Practice Address - Country:US
Practice Address - Phone:407-951-5749
Practice Address - Fax:407-951-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN167051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076030700Medicaid