MEDICARE: DR. RONALD GARRETT DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	042678	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215028147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD GARRETT DDS

Provider Business Mailing Address
First Line	:	1113 MARC DR
Second Line	:
City	:	NORTH WOODMERE
State	:	NY
Zip	:	11581
Country	:	US
Telephone Number	:	516-791-5059
Fax Number	:

Provider Business Practice Location Address
First Line	:	17605 137TH AVE
Second Line	:
City	:	SPRINGFIELD GARDENS
State	:	NY
Zip	:	11434
Country	:	US
Telephone Number	:	718-528-5949
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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