Provider Demographics
NPI:1912059072
Name:STARR, GARRETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:
Last Name:STARR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N AUGUSTA CT
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-8707
Mailing Address - Country:US
Mailing Address - Phone:507-625-7172
Mailing Address - Fax:
Practice Address - Street 1:120 N AUGUSTA CT
Practice Address - Street 2:SUITE 108
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-8707
Practice Address - Country:US
Practice Address - Phone:507-625-7172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9686122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU 45263Medicare UPIN