Healthcare Provider Details

I. General information

NPI: 1962767384
Provider Name (Legal Business Name): CODY GUY GARRISON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 YORK ST
DENVER CO
80205-3540
US

IV. Provider business mailing address

3800 YORK ST
DENVER CO
80205-3540
US

V. Phone/Fax

Practice location:
  • Phone: 701-550-9016
  • Fax:
Mailing address:
  • Phone: 701-550-9016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number10737
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: