Provider Demographics
NPI:1265793582
Name:GARRETT, JAMES LAWRENCE
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LAWRENCE
Last Name:GARRETT
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 1:3201 LAWRENCE RD STE 375
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-1638
Mailing Address - Country:US
Mailing Address - Phone:940-691-4867
Mailing Address - Fax:
Practice Address - Street 1:4111 SOUTHWEST PKWY STE 500
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-4303
Practice Address - Country:US
Practice Address - Phone:940-301-3669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX278681223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice