Provider Demographics
NPI:1497974141
Name:DOCTORS GARRARD AND WAYMENT DENTISTS PLLC
Entity Type:Organization
Organization Name:DOCTORS GARRARD AND WAYMENT DENTISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARRARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-436-6406
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-0338
Mailing Address - Country:US
Mailing Address - Phone:208-436-6406
Mailing Address - Fax:208-436-9678
Practice Address - Street 1:301 SCOTT AVE
Practice Address - Street 2:STE #3
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-1800
Practice Address - Country:US
Practice Address - Phone:208-436-6406
Practice Address - Fax:208-436-9678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD34001223G0001X
IDD39651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty