Healthcare Provider Details

I. General information

NPI: 1902805997
Provider Name (Legal Business Name): DAVID TOD GARNER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2363 DUNN AVE
JACKSONVILLE FL
32218-4601
US

IV. Provider business mailing address

2363 DUNN AVE
JACKSONVILLE FL
32218-4601
US

V. Phone/Fax

Practice location:
  • Phone: 904-751-6030
  • Fax: 904-751-5828
Mailing address:
  • Phone: 904-751-6030
  • Fax: 904-751-5828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN9611
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: