Provider Demographics
NPI:1073942736
Name:GARRISON FAMILY DENTISTRY
Entity Type:Organization
Organization Name:GARRISON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-532-8778
Mailing Address - Street 1:14790 N US HIGHWAY 169
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64089-8727
Mailing Address - Country:US
Mailing Address - Phone:816-532-8778
Mailing Address - Fax:816-532-3310
Practice Address - Street 1:14790 N US HIGHWAY 169
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:MO
Practice Address - Zip Code:64089-8727
Practice Address - Country:US
Practice Address - Phone:816-532-8778
Practice Address - Fax:816-532-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty