Healthcare Provider Details

I. General information

NPI: 1114972130
Provider Name (Legal Business Name): MICHAEL CLAY GARVER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19260 N MOBILE ST
CITRONELLE AL
36522-2122
US

IV. Provider business mailing address

19260 N MOBILE ST PO BOX 426
CITRONELLE AL
36522-2122
US

V. Phone/Fax

Practice location:
  • Phone: 251-866-5585
  • Fax: 251-252-9112
Mailing address:
  • Phone: 251-866-5585
  • Fax: 251-252-9112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3039
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: