Provider Demographics
NPI:1548548803
Name:GARLOCK, DAVID TIMOTHY
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:TIMOTHY
Last Name:GARLOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 S GUN CLUB RD UNIT E1
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5302
Mailing Address - Country:US
Mailing Address - Phone:303-627-6212
Mailing Address - Fax:303-627-1725
Practice Address - Street 1:6020 S GUN CLUB RD UNIT E1
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5302
Practice Address - Country:US
Practice Address - Phone:303-627-6212
Practice Address - Fax:303-627-1725
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN002018731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics