Provider Demographics
NPI:1760470850
Name:GARRETT, MICHAEL CREED (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CREED
Last Name:GARRETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 RAVEN HILL CT
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-7212
Mailing Address - Country:US
Mailing Address - Phone:865-671-3290
Mailing Address - Fax:
Practice Address - Street 1:1522 CHEROKEE TRL
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-2205
Practice Address - Country:US
Practice Address - Phone:865-549-5278
Practice Address - Fax:865-594-6291
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48791223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3204025Medicaid