Provider Demographics
NPI:1881246726
Name:GARRETT FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:GARRETT FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDROZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-894-4044
Mailing Address - Street 1:907 LINCOLNWAY S
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:IN
Mailing Address - Zip Code:46767-1707
Mailing Address - Country:US
Mailing Address - Phone:260-894-4044
Mailing Address - Fax:260-577-8117
Practice Address - Street 1:125 S RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:GARRETT
Practice Address - State:IN
Practice Address - Zip Code:46738-1467
Practice Address - Country:US
Practice Address - Phone:260-357-3171
Practice Address - Fax:260-357-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty