Healthcare Provider Details

I. General information

NPI: 1154780534
Provider Name (Legal Business Name): R. ANDRES GARCIA, DDS, APDC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12750 CARMEL COUNTRY RD SUITE 209
SAN DIEGO CA
92130-2159
US

IV. Provider business mailing address

12750 CARMEL COUNTRY RD SUITE 209
SAN DIEGO CA
92130-2159
US

V. Phone/Fax

Practice location:
  • Phone: 858-755-7805
  • Fax:
Mailing address:
  • Phone: 858-755-7805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAUL ANDRES GARCIA
Title or Position: OWNER
Credential: DDS
Phone: 858-755-7805