Provider Demographics
NPI:1215283056
Name:GARNER, STACI J (DMD)
Entity type:Individual
Prefix:DR
First Name:STACI
Middle Name:J
Last Name:GARNER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:526 S TONOPAH DR
Mailing Address - Street 2:STE. 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4043
Mailing Address - Country:US
Mailing Address - Phone:702-291-2031
Mailing Address - Fax:702-366-1483
Practice Address - Street 1:4035 S DURANGO DR
Practice Address - Street 2:#103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-4161
Practice Address - Country:US
Practice Address - Phone:702-804-8888
Practice Address - Fax:702-804-0559
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV6314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1215283056Medicaid