MEDICARE: DR. JOHN WILSON GARNETT III 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	8259	TX

General Provider Information

NPI Number	:	1992700777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN WILSON GARNETT III DDS

Provider Business Mailing Address
First Line	:	2417 PARK HILL DR
Second Line	:	STE D
City	:	FORT WORTH
State	:	TX
Zip	:	76110-2200
Country	:	US
Telephone Number	:	817-926-9771
Fax Number	:	817-926-9781

Provider Business Practice Location Address
First Line	:	2417 PARK HILL DR
Second Line	:	STE D
City	:	FORT WORTH
State	:	TX
Zip	:	76110-2200
Country	:	US
Telephone Number	:	817-926-9771
Fax Number	:	817-926-9781

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/08/2007

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