Provider Demographics
NPI:1023120649
Name:DOWNER-GARNETTE, MERYS
Entity type:Individual
Prefix:
First Name:MERYS
Middle Name:
Last Name:DOWNER-GARNETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N LAKEMONT AVE
Mailing Address - Street 2:STE D
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3205
Mailing Address - Country:US
Mailing Address - Phone:407-951-5749
Mailing Address - Fax:407-951-5765
Practice Address - Street 1:315 N LAKEMONT AVE
Practice Address - Street 2:STE D
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3205
Practice Address - Country:US
Practice Address - Phone:407-951-5749
Practice Address - Fax:407-951-5765
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN167051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076030700Medicaid