Healthcare Provider Details

I. General information

NPI: 1912022047
Provider Name (Legal Business Name): KIMBERLY ANN GARCIA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 REKDAL RD
CAMANO ISLAND WA
98282-8852
US

IV. Provider business mailing address

810 REKDAL RD
CAMANO ISLAND WA
98282-8852
US

V. Phone/Fax

Practice location:
  • Phone: 360-629-4097
  • Fax: 360-629-3906
Mailing address:
  • Phone: 360-629-4097
  • Fax: 360-629-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00007673
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: