Provider Demographics
NPI:1891826483
Name:RAYMOND GARRISON DDS PA - UDA
Entity Type:Organization
Organization Name:RAYMOND GARRISON DDS PA - UDA
Other - Org Name:WATLINGTON HALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-549-1509
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:WATLINGTON HALL
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-2160
Mailing Address - Fax:336-716-2656
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:WATLINGTON HALL
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2160
Practice Address - Fax:336-716-2656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3549122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty