Provider Demographics
NPI:1427787175
Name:JUSTIN GARNER DENTISTRY
Entity type:Organization
Organization Name:JUSTIN GARNER DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-422-0095
Mailing Address - Street 1:3904 S LYNN CT
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-3338
Mailing Address - Country:US
Mailing Address - Phone:816-252-0055
Mailing Address - Fax:
Practice Address - Street 1:3904 S LYNN CT
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-3338
Practice Address - Country:US
Practice Address - Phone:816-252-0055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty