Healthcare Provider Details

I. General information

NPI: 1295800472
Provider Name (Legal Business Name): GARRET F HARNETT DDS, MS, PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18555 N 79TH AVE SUITE A-102
GLENDALE AZ
85308-8370
US

IV. Provider business mailing address

18555 N 79TH AVE SUITE A-102
GLENDALE AZ
85308-8370
US

V. Phone/Fax

Practice location:
  • Phone: 623-487-5800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD1706
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: