Provider Demographics
NPI:1821117763
Name:GARN, VAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:VAL
Middle Name:
Last Name:GARN
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 1:2200 PARKE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-3351
Mailing Address - Country:US
Mailing Address - Phone:208-678-8980
Mailing Address - Fax:208-678-4316
Practice Address - Street 1:2200 PARKE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-3351
Practice Address - Country:US
Practice Address - Phone:208-678-8980
Practice Address - Fax:208-678-4316
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD31281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010010307OtherREGENCE BLUE SHIELD
ID6312-3OtherBLUE CROSS OF IDAHO