Healthcare Provider Details

I. General information

NPI: 1265010847
Provider Name (Legal Business Name): OMAR GARCIA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: OMAR GUILLERMO GARCIA CHACON DMD

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 07/22/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 PLAINFIELD RD
WEST LEBANON NH
03784-2026
US

IV. Provider business mailing address

919 HILLCREST DR APT 801
HOLLYWOOD FL
33021-7883
US

V. Phone/Fax

Practice location:
  • Phone: 954-805-1908
  • Fax:
Mailing address:
  • Phone: 954-805-1908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number04745
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: