Provider Demographics
NPI:1427217488
Name:GARY J GARRISON DDS INC
Entity Type:Organization
Organization Name:GARY J GARRISON DDS INC
Other - Org Name:GARRISON FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-494-7222
Mailing Address - Street 1:22100 BULVERDE ROAD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259
Mailing Address - Country:US
Mailing Address - Phone:210-494-7222
Mailing Address - Fax:210-494-7227
Practice Address - Street 1:22100 BULVERDE ROAD
Practice Address - Street 2:SUITE 114
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259
Practice Address - Country:US
Practice Address - Phone:210-494-7222
Practice Address - Fax:210-494-7227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARY J GARRISON DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12112122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty