Provider Demographics
NPI:1033421086
Name:GARCIA, SHARLA (RDH)
Entity Type:Individual
Prefix:
First Name:SHARLA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 VISTA PATRON
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-5380
Mailing Address - Country:US
Mailing Address - Phone:505-550-5773
Mailing Address - Fax:505-771-8275
Practice Address - Street 1:155B CAPITOL SQUARE DR
Practice Address - Street 2:
Practice Address - City:ZIA PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87053-6013
Practice Address - Country:US
Practice Address - Phone:505-867-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH2807124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist