Healthcare Provider Details

I. General information

NPI: 1518015528
Provider Name (Legal Business Name): MODESTO GARCIA D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 11 BLOQUE 33 NO 4 URB VILLA CAROLINA
CAROLINA PR
00985
US

IV. Provider business mailing address

URB GARCIA 24 CALLE C
SAN JUAN PR
00926-5135
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-7216
  • Fax:
Mailing address:
  • Phone: 787-790-3391
  • Fax: 787-790-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number589
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: