Provider Demographics
NPI:1568592434
Name:RAYMOND GARRISON DDS PA - UDA
Entity Type:Organization
Organization Name:RAYMOND GARRISON DDS PA - UDA
Other - Org Name:WAVERLY PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-549-1509
Mailing Address - Street 1:200 KEISLER DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-8801
Mailing Address - Country:US
Mailing Address - Phone:919-851-6330
Mailing Address - Fax:919-851-6089
Practice Address - Street 1:200 KEISLER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-8801
Practice Address - Country:US
Practice Address - Phone:919-851-6330
Practice Address - Fax:919-851-6089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3549122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty