Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 4879 | TN |
NPI | 1760470850 |
---|---|
Provider Name | Dr. Michael Creed Garrett |
First Address | Knoxville, TN 37922-7212 |
Second Address | Knoxville, TN 37920-2205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3204025 | (05) | TN |