Provider Demographics
NPI:1073689790
Name:GARRETT, WAYNE HARISON (DMD)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:HARISON
Last Name:GARRETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ANDREW STREET
Mailing Address - Street 2:SUITE F
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950
Mailing Address - Country:US
Mailing Address - Phone:256-878-7830
Mailing Address - Fax:256-878-7830
Practice Address - Street 1:100 ANDREW STREET
Practice Address - Street 2:SUITE F
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950
Practice Address - Country:US
Practice Address - Phone:256-878-7830
Practice Address - Fax:256-878-7830
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL34171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics