Provider Demographics
NPI:1588731129
Name:GARRISON, CLYDE MCALISTER III (DDS)
Entity type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:MCALISTER
Last Name:GARRISON
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:CLYDE
Other - Middle Name:MCALISTER
Other - Last Name:GARRISON
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:129 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3751
Mailing Address - Country:US
Mailing Address - Phone:540-434-5702
Mailing Address - Fax:540-574-4944
Practice Address - Street 1:129 UNIVERSITY BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3751
Practice Address - Country:US
Practice Address - Phone:540-434-5702
Practice Address - Fax:540-574-4944
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist