Healthcare Provider Details

I. General information

NPI: 1306917604
Provider Name (Legal Business Name): GARRET DJEU D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10875 MAIN ST #106
FAIRFAX VA
22030-4732
US

IV. Provider business mailing address

10875 MAIN ST #106
FAIRFAX VA
22030-4732
US

V. Phone/Fax

Practice location:
  • Phone: 703-691-8388
  • Fax: 703-385-7381
Mailing address:
  • Phone: 703-691-8388
  • Fax: 703-385-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401411553
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: