Provider Demographics
NPI:1902920606
Name:GARRETT, MAURICE B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:B
Last Name:GARRETT
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 1:12071 BRICKSOME AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2339
Mailing Address - Country:US
Mailing Address - Phone:225-292-8101
Mailing Address - Fax:225-293-2767
Practice Address - Street 1:12071 BRICKSOME AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2339
Practice Address - Country:US
Practice Address - Phone:225-292-8101
Practice Address - Fax:225-293-2767
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA35461223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics