Healthcare Provider Details

I. General information

NPI: 1033223094
Provider Name (Legal Business Name): BENJAMIN L GARR D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 4TH AVE S STE 201
CARRINGTON ND
58421-2321
US

IV. Provider business mailing address

PO BOX 537
CARRINGTON ND
58421-0537
US

V. Phone/Fax

Practice location:
  • Phone: 701-652-2300
  • Fax: 701-652-2303
Mailing address:
  • Phone: 701-652-2300
  • Fax: 701-652-2303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5927687-9922
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5927687-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: