Healthcare Provider Details

I. General information

NPI: 1356712087
Provider Name (Legal Business Name): PHILLIP GARRETT JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 06/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 E WILLIAMS FIELD RD STE 104
GILBERT AZ
85295-0707
US

IV. Provider business mailing address

2080 E WILLIAMS FIELD RD STE 104
GILBERT AZ
85295-0707
US

V. Phone/Fax

Practice location:
  • Phone: 361-343-6272
  • Fax:
Mailing address:
  • Phone: 361-343-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD009953
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: