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General NPI Number Information
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NPI Number | 1407179369
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Entity Type | Organization
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Legal Business Name | ELIZABETH GARCIA, DDS PROF. DENTAL CORP.
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 03/08/2010
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Provider Practice Location Address
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Address Line | 4170 TWEEDY BLVD
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City | SOUTH GATE
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State | CA
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Zip | 90280-6147
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Country | US
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Telephone | 323-564-1745
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Fax | 323-564-1779
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Provider Business Mailing Address
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Address Line | 4170 TWEEDY BLVD
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City | SOUTH GATE
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State | CA
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Zip | 90280-6147
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Country | US
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Telephone | 323-564-1745
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Fax | 323-564-1779
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Authorized Official
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Title or Position | PRESIDENT/DENTIST OWNER
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Name | ELIZABETH GARCIA
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Credential | DDS
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Telephone | 323-564-1745
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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 | #47078
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License Number State | CA
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