Provider Demographics
NPI:1952509036
Name:GAREY, MISHA WIEGAND (DDS)
Entity Type:Individual
Prefix:DR
First Name:MISHA
Middle Name:WIEGAND
Last Name:GAREY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 RESERVE WAY STE 106
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7920
Mailing Address - Country:US
Mailing Address - Phone:615-766-2600
Mailing Address - Fax:
Practice Address - Street 1:6106 SHALLOWFORD RD STE 116
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2280
Practice Address - Country:US
Practice Address - Phone:423-521-4210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8686122300000X, 1223G0001X
AL59761223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist