Healthcare Provider Details

I. General information

NPI: 1407113228
Provider Name (Legal Business Name): JEFFREY WILLIAM GARCIA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 CALIFORNIA BLVD
SAN LUIS OBISPO CA
93401-2580
US

IV. Provider business mailing address

683 CALIFORNIA BLVD
SAN LUIS OBISPO CA
93401-2580
US

V. Phone/Fax

Practice location:
  • Phone: 310-975-5090
  • Fax:
Mailing address:
  • Phone: 310-975-5090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number62013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: