Healthcare Provider Details

I. General information

NPI: 1245675107
Provider Name (Legal Business Name): IDALMES GARCIA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE # 2005
MIAMI FL
33136-1003
US

IV. Provider business mailing address

10581 SW 27TH ST
MIAMI FL
33165-2709
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-6725
  • Fax:
Mailing address:
  • Phone: 786-312-9082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN 21579
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: