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General NPI Number Information
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NPI Number | 1417288663
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Entity Type | Organization
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Legal Business Name | MONICA GARNACHE DMD INC
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Dates
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Enumeration Date | 01/27/2010
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 630 FREITAS PKWY
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City | SAN RAFAEL
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State | CA
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Zip | 94903-3106
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Country | US
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Telephone | 415-479-1273
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Fax | 415-479-9840
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Provider Business Mailing Address
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Address Line | 630 FREITAS PKWY
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City | SAN RAFAEL
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State | CA
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Zip | 94903-3106
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Country | US
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Telephone | 415-479-1273
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Fax | 415-479-9840
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Authorized Official
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Title or Position | PRESIDENT
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Name | MONICA A GARNACHE
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Credential | DMD
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Telephone | 415-479-1273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 55432
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License Number State | CA
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