Provider Demographics
NPI:1235325457
Name:GARRETT, BRETT JAMES (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:JAMES
Last Name:GARRETT
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3916
Mailing Address - Country:US
Mailing Address - Phone:805-544-3223
Mailing Address - Fax:
Practice Address - Street 1:1312 GARDEN ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3916
Practice Address - Country:US
Practice Address - Phone:805-544-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics