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General NPI Number Information
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NPI Number | 1982922522
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Entity Type | Organization
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Legal Business Name | DR. JEANNIE B. GARCIA DENTAL INC
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 617 N AZUSA AVE
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City | COVINA
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State | CA
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Zip | 91722-3504
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Country | US
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Telephone | 626-332-4777
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Fax | 626-332-4781
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Provider Business Mailing Address
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Address Line | 4070 STERLING WAY
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City | BALDWIN PARK
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State | CA
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Zip | 91706-4223
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Country | US
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Telephone | 626-480-7777
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Fax | 626-480-7775
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JEANNIE BANEZ GARCIA
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Credential | D.M.D.
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Telephone | 626-480-7777
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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 | 50437
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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