MEDICARE: DR. ROGER LEE GARRETT 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
1	1223G0001X	General Practice Dentistry	28443	CA

General Provider Information

NPI Number	:	1780893222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER LEE GARRETT DDS

Provider Business Mailing Address
First Line	:	104 SATINWOOD AVE
Second Line	:
City	:	OAK PARK
State	:	CA
Zip	:	91377-1244
Country	:	US
Telephone Number	:	818-991-5182
Fax Number	:	818-991-8863

Provider Business Practice Location Address
First Line	:	23695 CALABASAS RD
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-1502
Country	:	US
Telephone Number	:	818-591-2480
Fax Number	:	818-591-7599

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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