Provider Demographics
NPI:1326167024
Name:GARRETT, JAMES WILMER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILMER
Last Name:GARRETT
Suffix:
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 1:1215 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3705
Mailing Address - Country:US
Mailing Address - Phone:208-882-9585
Mailing Address - Fax:208-883-8859
Practice Address - Street 1:1215 E 6TH ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3705
Practice Address - Country:US
Practice Address - Phone:208-882-9585
Practice Address - Fax:208-883-8859
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-33171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice