Healthcare Provider Details

I. General information

NPI: 1093893349
Provider Name (Legal Business Name): DAVID KENDEL GARRETSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11115 WURZBACH RD
SAN ANTONIO TX
78230-2643
US

IV. Provider business mailing address

PO BOX 40397
SAN ANTONIO TX
78229-1397
US

V. Phone/Fax

Practice location:
  • Phone: 210-877-2273
  • Fax:
Mailing address:
  • Phone: 210-450-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15911
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: