Healthcare Provider Details

I. General information

NPI: 1205031119
Provider Name (Legal Business Name): ROSENDO GARZA SR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 04/21/2022
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 E 33RD ST
SAN BERNARDINO CA
92404-2224
US

IV. Provider business mailing address

275 E 33RD ST
SAN BERNARDINO CA
92404-2224
US

V. Phone/Fax

Practice location:
  • Phone: 909-644-5363
  • Fax:
Mailing address:
  • Phone: 909-644-5363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number48272
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number48272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: