MEDICARE: DR. SARA YSAAC-GARCIA DMD

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	1223P0221X	Pediatric Dentistry	010994	CT

General Provider Information

NPI Number	:	1871782458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA YSAAC-GARCIA DMD

Provider Business Mailing Address
First Line	:	5211 MADISON AVE
Second Line	:
City	:	TRUMBULL
State	:	CT
Zip	:	06611-1040
Country	:	US
Telephone Number	:	203-767-3798
Fax Number	:

Provider Business Practice Location Address
First Line	:	990 STATE ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-3944
Country	:	US
Telephone Number	:	203-787-3669
Fax Number	:

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

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	08/29/2013

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