MEDICARE: DR. EDWARD G GARRY DMD

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
1	1223G0001X	General Practice Dentistry	12009233A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255537353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD G GARRY DMD

Provider Business Mailing Address
First Line	:	7015 US 31 STE C
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-8619
Country	:	US
Telephone Number	:	463-276-0541
Fax Number	:	463-276-0542

Provider Business Practice Location Address
First Line	:	7015 US 31 STE C
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-8619
Country	:	US
Telephone Number	:	463-276-0541
Fax Number	:	463-276-0542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	08/29/2024

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