Healthcare Provider Details

I. General information

NPI: 1982922522
Provider Name (Legal Business Name): DR. JEANNIE B. GARCIA DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 N AZUSA AVE
COVINA CA
91722-3504
US

IV. Provider business mailing address

4070 STERLING WAY
BALDWIN PARK CA
91706-4223
US

V. Phone/Fax

Practice location:
  • Phone: 626-332-4777
  • Fax: 626-332-4781
Mailing address:
  • Phone: 626-480-7777
  • Fax: 626-480-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number50437
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JEANNIE BANEZ GARCIA
Title or Position: DENTIST
Credential: D.M.D.
Phone: 626-480-7777