Healthcare Provider Details

I. General information

NPI: 1437780442
Provider Name (Legal Business Name): HIRAM A GARCIA DENTAL IMPLANTS AND ORAL SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19472 US ROUTE 11
WATERTOWN NY
13601-5387
US

IV. Provider business mailing address

PO BOX 49
WATERTOWN NY
13601-0049
US

V. Phone/Fax

Practice location:
  • Phone: 818-462-1703
  • Fax:
Mailing address:
  • Phone: 818-462-1703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. HIRAM AMADO GARCIA-RIVERA
Title or Position: OWNER
Credential: DMD
Phone: 818-462-1703