Provider Demographics
NPI:1992376107
Name:GARRETT, DAVID LEE (CPSS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:GARRETT
Suffix:
Gender:M
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 MARJORIE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-2348
Mailing Address - Country:US
Mailing Address - Phone:937-838-9598
Mailing Address - Fax:
Practice Address - Street 1:3440 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45439-2214
Practice Address - Country:US
Practice Address - Phone:937-299-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0002675175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist