Healthcare Provider Details

I. General information

NPI: 1508020660
Provider Name (Legal Business Name): JACKIE GARCIA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 SPRINGFIELD DR SUITE 100
BLOOMINGDALE IL
60108-2214
US

IV. Provider business mailing address

290 SPRINGFIELD DR SUITE 100
BLOOMINGDALE IL
60108-2214
US

V. Phone/Fax

Practice location:
  • Phone: 630-529-0027
  • Fax: 630-529-0068
Mailing address:
  • Phone: 630-529-0027
  • Fax: 630-529-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019-027578
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: