Healthcare Provider Details

I. General information

NPI: 1487941605
Provider Name (Legal Business Name): GARREN M PETREE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1858 CREST RD
MARYVILLE TN
37804-4305
US

IV. Provider business mailing address

1858 CREST RD
MARYVILLE TN
37804-4305
US

V. Phone/Fax

Practice location:
  • Phone: 865-977-7110
  • Fax: 865-977-4132
Mailing address:
  • Phone: 865-977-7110
  • Fax: 865-977-4132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9328
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: