Provider Demographics
NPI:1861656639
Name:GARRETT, GEORGE NEIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:NEIL
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 1:605 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-7810
Mailing Address - Country:US
Mailing Address - Phone:847-356-3777
Mailing Address - Fax:847-356-3864
Practice Address - Street 1:605 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-7810
Practice Address - Country:US
Practice Address - Phone:847-356-3777
Practice Address - Fax:847-356-3864
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190158691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1730191321OtherTYPE 2 G. NEIL GARRETT DDS PC