Provider Demographics
NPI:1649683046
Name:GARRETT, STEVEN A (DMD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:GARRETT
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 1:1947 CITRONA DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4492
Mailing Address - Country:US
Mailing Address - Phone:904-961-7181
Mailing Address - Fax:
Practice Address - Street 1:1947 CITRONA DR
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4492
Practice Address - Country:US
Practice Address - Phone:904-961-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20603122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist