Provider Demographics
NPI:1083096150
Name:GARCIA, DOROTHY ANNE EUGENIO (RDH, BSDH)
Entity Type:Individual
Prefix:
First Name:DOROTHY ANNE
Middle Name:EUGENIO
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RDH, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2426 70TH AVE W
Mailing Address - Street 2:APT. 215
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-5455
Mailing Address - Country:US
Mailing Address - Phone:360-362-6638
Mailing Address - Fax:
Practice Address - Street 1:2426 70TH AVE W
Practice Address - Street 2:APT. 215
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-5455
Practice Address - Country:US
Practice Address - Phone:360-362-6638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28675124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist