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General NPI Number Information
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NPI Number | 1629893805
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Entity Type | Organization
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Legal Business Name | GARRISON ORTHODONTICS LLC
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 300 EXECUTIVE DR STE 365
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City | WEST ORANGE
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State | NJ
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Zip | 07052-3327
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Country | US
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Telephone | 862-451-8117
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Fax | 862-451-8118
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Provider Business Mailing Address
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Address Line | 300 EXECUTIVE DR STE 365
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City | WEST ORANGE
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State | NJ
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Zip | 07052-3327
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Country | US
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Telephone | 862-451-8117
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Fax | 862-451-8118
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. GARRISON EUGENE COPELAND
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Credential | DDS, MSD
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Telephone | 862-451-8117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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