1588731129 NPI number — DR. CLYDE MCALISTER GARRISON III DDS

Table of content: DR. CLYDE MCALISTER GARRISON III DDS (NPI 1588731129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588731129 NPI number — DR. CLYDE MCALISTER GARRISON III DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARRISON
Provider First Name:
CLYDE
Provider Middle Name:
MCALISTER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARRISON
Provider Other First Name:
CLYDE
Provider Other Middle Name:
MCALISTER
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
III
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1588731129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
129 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
HARRISONBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22801-3751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-434-5702
Provider Business Mailing Address Fax Number:
540-574-4944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
HARRISONBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22801-3751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-434-5702
Provider Business Practice Location Address Fax Number:
540-574-4944
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  0401006143 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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