Healthcare Provider Details

I. General information

NPI: 1447061817
Provider Name (Legal Business Name): EDGAR GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 NEWTON RD
IOWA CITY IA
52242-8004
US

IV. Provider business mailing address

849 AIDEN ST
IOWA CITY IA
52245-2130
US

V. Phone/Fax

Practice location:
  • Phone: 319-335-2555
  • Fax:
Mailing address:
  • Phone: 319-512-6130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberFAC-40236
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: