Healthcare Provider Details

I. General information

NPI: 1114294063
Provider Name (Legal Business Name): GABRIEL GARCIA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE PRIMERA SUITE 101-B
LOS ALGODONES BAJA CALIFORNIA
21970
MX

IV. Provider business mailing address

9544 S ARABY RD
YUMA AZ
85365-1100
US

V. Phone/Fax

Practice location:
  • Phone: 658-517-7601
  • Fax:
Mailing address:
  • Phone: 928-246-4310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4399143
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: