Provider Demographics
NPI:1710566518
Name:GARRETT, ELAINE LABOR (RDH, CSOM)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:LABOR
Last Name:GARRETT
Suffix:
Gender:F
Credentials:RDH, CSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CHILI RD
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-7031
Mailing Address - Country:US
Mailing Address - Phone:505-450-1445
Mailing Address - Fax:
Practice Address - Street 1:5701 CARMEL AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2842
Practice Address - Country:US
Practice Address - Phone:505-265-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH4371124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist