Provider Demographics
NPI:1790301802
Name:MARCHANT, GARRET JORDAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARRET
Middle Name:JORDAN
Last Name:MARCHANT
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 1:1302 PIONEER RD
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9108
Mailing Address - Country:US
Mailing Address - Phone:906-250-4621
Mailing Address - Fax:
Practice Address - Street 1:989 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4064
Practice Address - Country:US
Practice Address - Phone:906-226-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600619122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist