Provider Demographics
NPI:1043304223
Name:GARRETT, KENNETH (DDS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5081 W HESSLER RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-8960
Mailing Address - Country:US
Mailing Address - Phone:765-286-8090
Mailing Address - Fax:
Practice Address - Street 1:5081 W HESSLER RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-8960
Practice Address - Country:US
Practice Address - Phone:765-286-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007238A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist