Provider Demographics
NPI:1992700777
Name:GARNETT, JOHN WILSON III (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILSON
Last Name:GARNETT
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:MRS
Other - First Name:PHYLLIS
Other - Middle Name:J
Other - Last Name:HUPPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SECRETARY
Mailing Address - Street 1:2417 PARK HILL DR
Mailing Address - Street 2:STE D
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-2200
Mailing Address - Country:US
Mailing Address - Phone:817-926-9771
Mailing Address - Fax:817-926-9781
Practice Address - Street 1:2417 PARK HILL DR
Practice Address - Street 2:STE D
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-2200
Practice Address - Country:US
Practice Address - Phone:817-926-9771
Practice Address - Fax:817-926-9781
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice