Healthcare Provider Details

I. General information

NPI: 1144213802
Provider Name (Legal Business Name): PETER GARCIA D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11084 SE OAK ST
MILWAUKIE OR
97222-6692
US

IV. Provider business mailing address

11084 SE OAK ST
MILWAUKIE OR
97222-6692
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-9667
  • Fax: 503-786-5971
Mailing address:
  • Phone: 503-659-9667
  • Fax: 503-786-5971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6066
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: