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General NPI Number Information
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NPI Number | 1114309747
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Entity Type | Individual
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Provider Name | MARIELA GARCIA DE LA NOCEDA DMD
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Gender | Female
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Dates
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Enumeration Date | 06/19/2015
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Last Update Date | 08/08/2016
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Provider Practice Location Address
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Address Line | 1942 STATE ST
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City | COLUMBUS
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State | IN
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Zip | 47201-6966
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Country | US
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Telephone | 787-810-9193
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Fax |
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Provider Business Mailing Address
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Address Line | 335 W 9TH ST UNIT 1010
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-3121
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Country | US
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Telephone | 787-810-9193
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4779887
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License Number State | PR
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