Provider Demographics
NPI:1942468574
Name:GARNER, JACQUELINE YVETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:YVETTE
Last Name:GARNER
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 1:2211 EXECUTIVE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-3661
Mailing Address - Country:US
Mailing Address - Phone:704-395-6000
Mailing Address - Fax:704-398-7373
Practice Address - Street 1:2211 EXECUTIVE ST
Practice Address - Street 2:SUITE E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3661
Practice Address - Country:US
Practice Address - Phone:704-395-6000
Practice Address - Fax:704-398-7373
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4734Medicaid