Healthcare Provider Details

I. General information

NPI: 1710285804
Provider Name (Legal Business Name): RYAN J GARCIA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 MAIN STREET SUITE #B-2
MORRO BAY CA
93442
US

IV. Provider business mailing address

545 MAIN STREET SUITE #B-2
MORRO BAY CA
93442
US

V. Phone/Fax

Practice location:
  • Phone: 805-772-2731
  • Fax:
Mailing address:
  • Phone: 805-772-2731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number59451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: