Provider Demographics
NPI:1477662328
Name:GARNETT, JOHN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:GARNETT
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 1:523 BROADWAY
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1111
Mailing Address - Country:US
Mailing Address - Phone:845-794-0706
Mailing Address - Fax:845-794-0606
Practice Address - Street 1:523 BROADWAY
Practice Address - Street 2:SUITE # 1
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1111
Practice Address - Country:US
Practice Address - Phone:845-794-0706
Practice Address - Fax:845-794-0606
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030162-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00298297Medicaid