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NPI Code Detail

MEDICARE: DR. GARRETT DAVID GAST DDS

MEDICARE: DR. GARRETT DAVID GAST DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist56258CA
2122300000XDentist019028623IL
3122300000XDentist9844KY

General Provider Information

NPI Number : 1154595379
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARRETT DAVID GAST DDS
Provider Business Mailing Address
First Line : 8700 DIXIE HIGHWAY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40258
Country : US
Telephone Number : 502-935-0505
Fax Number : 502-935-2602
Provider Business Practice Location Address
First Line : 3435 W IRVING PARK RD
Second Line :
City : CHICAGO
State : IL
Zip : 60618-3217
Country : US
Telephone Number : 773-588-8200
Fax Number : 773-588-8208
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2008
Last Update Date : 09/02/2016

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