=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184154742
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROLAND GARCIA DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2017
-----------------------------------------------------
Last Update Date | 02/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3817 GRUBER RD
-----------------------------------------------------
City | FORT LIBERTY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28310-8925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-247-9432
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2817 ROCK MERRITT AVE STOP A
-----------------------------------------------------
City | FORT BRAGG
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28310-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-907-8707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN2293
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN2293
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------