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General NPI Number Information
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NPI Number | 1720203102
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Entity Type | Organization
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Legal Business Name | CHAD GARRISON PC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1419 N. MAIN
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City | JAY
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State | OK
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Zip | 74346
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Country | US
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Telephone | 918-253-3331
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Fax | 918-253-8011
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Provider Business Mailing Address
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Address Line | PO BOX 988
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City | JAY
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State | OK
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Zip | 74346-0988
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Country | US
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Telephone | 918-253-3331
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Fax | 918-253-8011
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | CHRISTY YOUNGBLOOD
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Credential |
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Telephone | 918-253-3331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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