Healthcare Provider Details

I. General information

NPI: 1629517040
Provider Name (Legal Business Name): GARRETT WINGROVE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 HANOVER ST
BOSTON MA
02113-1901
US

IV. Provider business mailing address

332 HANOVER ST
BOSTON MA
02113-1901
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-8000
  • Fax:
Mailing address:
  • Phone: 617-643-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN1857974
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: