=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164839650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSALVA M GARCIA A DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2014
-----------------------------------------------------
Last Update Date | 07/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1614 FRENCH ST
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92701-2419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-541-0891
-----------------------------------------------------
Fax | 714-541-0894
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1614 FRENCH ST
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92701-2419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-541-0891
-----------------------------------------------------
Fax | 714-541-0894
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PROF. ROSALVA M GARCIA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 714-541-0891
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 37108
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------