Provider Demographics
NPI:1982867974
Name:GARRETT, BEVERLY JOANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:JOANN
Last Name:GARRETT
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:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-0700
Mailing Address - Country:US
Mailing Address - Phone:304-728-8199
Mailing Address - Fax:304-728-8165
Practice Address - Street 1:213 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-1613
Practice Address - Country:US
Practice Address - Phone:304-728-8199
Practice Address - Fax:304-728-8165
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice