Basic Information
| Provider Information | |||||||||
| NPI: | 1194883595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARNER | ||||||||
| FirstName: | SHALISA | ||||||||
| MiddleName: | |||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3360 W FM 544 | ||||||||
| Address2: | SUITE 930 | ||||||||
| City: | WYLIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750989424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729150484 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3360 W FM 544 | ||||||||
| Address2: | SUITE 930 | ||||||||
| City: | WYLIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750989424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729150484 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 05/27/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 22991 | TX | Y | Dental Providers | Dentist | General Practice |
No ID Information.