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General NPI Number Information
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NPI Number | 1831106624
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Entity Type | Individual
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Provider Name | STACEY G GARRISON D.D.S
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1675 SOUTH M-37 HWY
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City | HASTINGS
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State | MI
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Zip | 49058
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Country | US
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Telephone | 269-948-8525
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Fax | 269-948-9786
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Provider Business Mailing Address
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Address Line | 1675 S. M-37 HWY P.O. BOX 267
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City | HASTINGS
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State | MI
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Zip | 49058
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Country | US
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Telephone | 269-948-8525
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Fax | 269-948-9786
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 013145
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License Number State | MI
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