Healthcare Provider Details

I. General information

NPI: 1740891712
Provider Name (Legal Business Name): GABRIEL ALBERTO GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 06/30/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BG CRAWFORD F. SAMS HEALTH CLINIC UNIT 45011, CAMP ZAMA DENTAL CLINIC
APO AP
96343-5011
US

IV. Provider business mailing address

BG CRAWFORD F. SAMS HEALTH CLINIC UNIT 45011, CAMP ZAMA DENTAL CLINIC
APO AP
96343-5011
US

V. Phone/Fax

Practice location:
  • Phone: 315-263-8331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11636
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: