Provider Demographics
NPI:1093733883
Name:SCOTT W GARRISON, D.D.S., M.S.D., P.C.
Entity Type:Organization
Organization Name:SCOTT W GARRISON, D.D.S., M.S.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-566-2217
Mailing Address - Street 1:422 MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3806
Mailing Address - Country:US
Mailing Address - Phone:610-566-2217
Mailing Address - Fax:610-566-7539
Practice Address - Street 1:422 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3806
Practice Address - Country:US
Practice Address - Phone:610-566-2217
Practice Address - Fax:610-566-7539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025610L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty