MEDICARE: DR. NICHOLAS RAYMOND GARCIA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	060518	NY

General Provider Information

NPI Number	:	1811494909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS RAYMOND GARCIA D.D.S.

Provider Business Mailing Address
First Line	:	172 LAFAYETTE PKWY
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14625-2059
Country	:	US
Telephone Number	:	585-315-3261
Fax Number	:

Provider Business Practice Location Address
First Line	:	1859 LAKE RD
Second Line	:
City	:	HAMLIN
State	:	NY
Zip	:	14464-9527
Country	:	US
Telephone Number	:	585-964-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2018
Last Update Date	:	10/19/2021

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