Provider Demographics
NPI:1629893805
Name:GARRISON ORTHODONTICS LLC
Entity type:Organization
Organization Name:GARRISON ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRISON
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:862-451-8117
Mailing Address - Street 1:300 EXECUTIVE DR STE 365
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3327
Mailing Address - Country:US
Mailing Address - Phone:862-451-8117
Mailing Address - Fax:862-451-8118
Practice Address - Street 1:300 EXECUTIVE DR STE 365
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-3327
Practice Address - Country:US
Practice Address - Phone:862-451-8117
Practice Address - Fax:862-451-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty