Provider Demographics
NPI:1760044390
Name:GARNER, JUSTIN S (DMD)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:S
Last Name:GARNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 S LINDBERGH BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7839
Mailing Address - Country:US
Mailing Address - Phone:314-732-4591
Mailing Address - Fax:314-200-9691
Practice Address - Street 1:811 HAZELWEST DR
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1749
Practice Address - Country:US
Practice Address - Phone:314-731-7555
Practice Address - Fax:314-731-7562
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190197121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice