Provider Demographics
NPI:1639828734
Name:GARSICK, NANCY (RDH)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:GARSICK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72051 SUNNYSLOPE DR
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-2065
Mailing Address - Country:US
Mailing Address - Phone:760-831-1210
Mailing Address - Fax:
Practice Address - Street 1:1591 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92278
Practice Address - Country:US
Practice Address - Phone:760-830-7054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22HI00645000390200000X, 124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program