Provider Demographics
NPI:1801496419
Name:GARRETT S STIGALL, DDS, MD, PA
Entity type:Organization
Organization Name:GARRETT S STIGALL, DDS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:STIGALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:828-264-7842
Mailing Address - Street 1:240 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5018
Mailing Address - Country:US
Mailing Address - Phone:828-264-7842
Mailing Address - Fax:828-264-0627
Practice Address - Street 1:240 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5018
Practice Address - Country:US
Practice Address - Phone:828-264-7842
Practice Address - Fax:828-264-0627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14401095OtherCAQH
NC1223S0112XMedicaid