Provider Demographics
NPI:1326236332
Name:GARCIA, YESENIA (DMD)
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12004 SHADOW CREEK PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7327
Mailing Address - Country:US
Mailing Address - Phone:713-436-1241
Mailing Address - Fax:713-730-3656
Practice Address - Street 1:12004 SHADOW CREEK PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584
Practice Address - Country:US
Practice Address - Phone:713-436-1241
Practice Address - Fax:713-730-3656
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22296332B00000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies