=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942407929
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATIVIDAD GARCIA D.D.S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2007
-----------------------------------------------------
Last Update Date | 07/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4501 BROADWAY
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10040-2409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-304-2229
-----------------------------------------------------
Fax | 212-304-1847
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 MORRELL PL
-----------------------------------------------------
City | GARFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07026-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-478-3327
-----------------------------------------------------
Fax | 212-304-1847
-----------------------------------------------------
=====================================================
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 | 048132
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------