Healthcare Provider Details

I. General information

NPI: 1417295213
Provider Name (Legal Business Name): JOSE A GARCIA RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N TELSHOR BLVD
LAS CRUCES NM
88011-8243
US

IV. Provider business mailing address

PO BOX 1853 119 SANTO YSIDRO
SANTA TERESA NM
88008-1853
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-5437
  • Fax: 575-522-4138
Mailing address:
  • Phone: 575-589-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH876
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: