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General NPI Number Information
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NPI Number | 1932269875
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Entity Type | Organization
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Legal Business Name | GARRISON HDH LLC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 1530 DORIS DR.
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City | FORT ATKINSON
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State | WI
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Zip | 53538
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Country | US
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Telephone | 920-563-9373
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Fax | 920-563-4664
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Provider Business Mailing Address
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Address Line | 1530 DORIS DR.
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City | FORT ATKINSON
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State | WI
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Zip | 53538
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Country | US
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Telephone | 920-563-9373
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Fax | 920-563-4664
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Authorized Official
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Title or Position | MANAGER
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Name | JAMES PAUL GARRISON
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Credential |
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Telephone | 920-563-9373
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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 | 5000615015
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License Number State | WI
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