Provider Demographics
NPI:1497921860
Name:GARRETT, WANDA FAYE (DDS)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:FAYE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 STERLING RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3865
Mailing Address - Country:US
Mailing Address - Phone:703-435-5051
Mailing Address - Fax:703-787-4618
Practice Address - Street 1:1031 STERLING RD
Practice Address - Street 2:SUITE 103
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3865
Practice Address - Country:US
Practice Address - Phone:703-435-5051
Practice Address - Fax:703-787-4618
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist