Provider Demographics
NPI:1558498048
Name:GARNER, CYNTHIA L (DDS)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:GARNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:L
Other - Last Name:HOLMES-GARNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3025 W MONTAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-5932
Mailing Address - Country:US
Mailing Address - Phone:843-744-2610
Mailing Address - Fax:843-744-7555
Practice Address - Street 1:3025 W MONTAGUE AVE
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-5932
Practice Address - Country:US
Practice Address - Phone:843-744-2610
Practice Address - Fax:843-744-7555
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4007Medicaid
SC881865OtherUNITED CONCORDIA DENTAL