Healthcare Provider Details

I. General information

NPI: 1487742847
Provider Name (Legal Business Name): JATHEN DAVID GARRETT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5711 39TH ST
GROVES TX
77619-3613
US

IV. Provider business mailing address

5711 39TH ST
GROVES TX
77619-3613
US

V. Phone/Fax

Practice location:
  • Phone: 409-962-1964
  • Fax: 409-962-6445
Mailing address:
  • Phone: 409-962-1964
  • Fax: 409-962-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19459-7
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: