Basic Information
| Provider Information | |||||||||
| NPI: | 1750729398 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARRETT | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 532 N TACOMA AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741276717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186055114 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1646 E 6TH ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741204001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188956933 | ||||||||
| FaxNumber: | 9185766887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2013 | ||||||||
| LastUpdateDate: | 06/05/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 6482 | OK | Y | Dental Providers | Dentist |
No ID Information.