Provider Demographics
NPI:1699952044
Name:GREGORY B. GARRETT, D.D.S., PA
Entity type:Organization
Organization Name:GREGORY B. GARRETT, D.D.S., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-763-3679
Mailing Address - Street 1:2215 DELANEY RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6010
Mailing Address - Country:US
Mailing Address - Phone:910-763-3679
Mailing Address - Fax:910-763-8115
Practice Address - Street 1:2215 DELANEY RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6010
Practice Address - Country:US
Practice Address - Phone:910-763-3679
Practice Address - Fax:910-763-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC63411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1215988381OtherINDIVIDUAL NPI
NC89-93088Medicaid