Provider Demographics
NPI:1427089317
Name:GARVIN, THOMAS MARVIN (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MARVIN
Last Name:GARVIN
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 1:2050 MERRIMAC LN N STE 201
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-2186
Mailing Address - Country:US
Mailing Address - Phone:763-476-4444
Mailing Address - Fax:
Practice Address - Street 1:2050 MERRIMAC LN N STE 201
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-2186
Practice Address - Country:US
Practice Address - Phone:763-476-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN98811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice