Provider Demographics
NPI:1134126485
Name:GARRISON, BRENT THOMAS (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:THOMAS
Last Name:GARRISON
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9860 WESTPOINT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3335
Mailing Address - Country:US
Mailing Address - Phone:317-841-1100
Mailing Address - Fax:317-841-2200
Practice Address - Street 1:9860 WESTPOINT DR
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3335
Practice Address - Country:US
Practice Address - Phone:317-841-1100
Practice Address - Fax:317-841-2200
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007989A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT34514Medicare UPIN
IN201980Medicare ID - Type Unspecified