Healthcare Provider Details

I. General information

NPI: 1457588410
Provider Name (Legal Business Name): DANIEL GARRISON DMD, CAGS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N 3RD ST STE 3
BURLINGTON IA
52601
US

IV. Provider business mailing address

700 N 3RD ST STE 3
BURLINGTON IA
52601-5043
US

V. Phone/Fax

Practice location:
  • Phone: 319-752-2025
  • Fax:
Mailing address:
  • Phone: 319-752-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN20381
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS-09518
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: