Provider Demographics
NPI:1285704759
Name:GARRISON, GARY J (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:GARRISON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22100 BULVERDE ROAD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2180
Mailing Address - Country:US
Mailing Address - Phone:210-494-7222
Mailing Address - Fax:210-494-7227
Practice Address - Street 1:22100 BULVERDE ROAD
Practice Address - Street 2:SUITE 114
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2180
Practice Address - Country:US
Practice Address - Phone:210-494-7222
Practice Address - Fax:210-494-7227
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice