Provider Demographics
NPI:1861684375
Name:GARVIN, THOMAS D (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
Last Name:GARVIN
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 1:201 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4337
Mailing Address - Country:US
Mailing Address - Phone:770-834-2521
Mailing Address - Fax:770-834-8446
Practice Address - Street 1:201 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4337
Practice Address - Country:US
Practice Address - Phone:770-834-2521
Practice Address - Fax:770-834-8446
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN000071681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice