Provider Demographics
NPI:1912022047
Name:GARCIA, KIMBERLY ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 REKDAL RD
Mailing Address - Street 2:
Mailing Address - City:CAMANO ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98282-8852
Mailing Address - Country:US
Mailing Address - Phone:360-629-4097
Mailing Address - Fax:360-629-3906
Practice Address - Street 1:810 REKDAL RD
Practice Address - Street 2:
Practice Address - City:CAMANO ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98282-8852
Practice Address - Country:US
Practice Address - Phone:360-629-4097
Practice Address - Fax:360-629-3906
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007673122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5024468Medicaid