Provider Demographics
NPI:1073854667
Name:GARRETT, THOMAS WARREN III (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WARREN
Last Name:GARRETT
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11402 CERCA DEL RIO PL
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2619
Mailing Address - Country:US
Mailing Address - Phone:813-988-5089
Mailing Address - Fax:
Practice Address - Street 1:11402 CERCA DEL RIO PL
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-2619
Practice Address - Country:US
Practice Address - Phone:813-988-5089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist