Healthcare Provider Details

I. General information

NPI: 1093700304
Provider Name (Legal Business Name): DAVID ANTHONY GARCIA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 571 #28
EL RITO NM
87530
US

IV. Provider business mailing address

HIGHWAY 571 #28
EL RITO NM
87530
US

V. Phone/Fax

Practice location:
  • Phone: 505-581-4728
  • Fax: 505-581-4789
Mailing address:
  • Phone: 505-581-4728
  • Fax: 505-581-4789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD1066
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: