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General NPI Number Information
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NPI Number | 1245334713
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Entity Type | Organization
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Legal Business Name | MARY ROSE GARCIA DMD INC
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1601 EL CAMINO REAL STE 305
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City | BELMONT
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State | CA
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Zip | 94002
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Country | US
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Telephone | 650-651-1601
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Fax | 650-551-1611
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Provider Business Mailing Address
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Address Line | 1601 EL CAMINO REAL STE 305
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City | BELMONT
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State | CA
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Zip | 94002
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Country | US
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Telephone | 650-651-1601
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Fax | 650-551-1611
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Authorized Official
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Title or Position | PRESIDENT GENERAL DENTIST
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Name | DR. MARY ROSE VENTURA GARCIA
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Credential | DMD
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Telephone | 650-551-1601
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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 | 40593
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License Number State | CA
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