Provider Demographics
NPI:1376554311
Name:GARROTT, LEA ANDY (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEA
Middle Name:ANDY
Last Name:GARROTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 EUREKA STREET
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606
Mailing Address - Country:US
Mailing Address - Phone:662-563-7644
Mailing Address - Fax:662-563-0453
Practice Address - Street 1:113 EUREKA STREET
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606
Practice Address - Country:US
Practice Address - Phone:662-563-7644
Practice Address - Fax:662-563-0453
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS196882122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00064953Medicaid