Provider Demographics
NPI:1194079343
Name:DAVID T. GARLOCK, D.M.D., M.S., P.C.
Entity type:Organization
Organization Name:DAVID T. GARLOCK, D.M.D., M.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:GARLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-317-4837
Mailing Address - Street 1:6020 S GUN CLUB RD UNIT E1
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5302
Mailing Address - Country:US
Mailing Address - Phone:303-627-6212
Mailing Address - Fax:303-627-1725
Practice Address - Street 1:6020 S GUN CLUB RD UNIT E1
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5302
Practice Address - Country:US
Practice Address - Phone:303-627-6212
Practice Address - Fax:303-627-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN002018731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty