Provider Demographics
NPI:1760829253
Name:GARRETT, ALAN MCKAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MCKAY
Last Name:GARRETT
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 1:3633 E YEAGER CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1611
Mailing Address - Country:US
Mailing Address - Phone:208-670-2914
Mailing Address - Fax:
Practice Address - Street 1:801 S PAULINA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7210
Practice Address - Country:US
Practice Address - Phone:208-670-2914
Practice Address - Fax:312-413-8006
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0297561223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry