Provider Demographics
NPI:1598475469
Name:GARNACHE DENTAL LLC
Entity Type:Organization
Organization Name:GARNACHE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNACHE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-944-3640
Mailing Address - Street 1:1127 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-3145
Mailing Address - Country:US
Mailing Address - Phone:401-944-3640
Mailing Address - Fax:401-944-0098
Practice Address - Street 1:1127 PARK AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3145
Practice Address - Country:US
Practice Address - Phone:401-944-3640
Practice Address - Fax:401-944-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty