Provider Demographics
NPI:1396311718
Name:CHARETTE, GARRETT (DMD)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:
Last Name:CHARETTE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 AZALEA GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7917
Mailing Address - Country:US
Mailing Address - Phone:413-313-6683
Mailing Address - Fax:
Practice Address - Street 1:3700 CRESTWOOD PKWY NW STE 180
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5583
Practice Address - Country:US
Practice Address - Phone:413-313-6683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18591841223X0400X
GA390200000X
GADN1228071223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice