MEDICARE: DR. ERNESTO GARCIA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	29279	CA

General Provider Information

NPI Number	:	1053560946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNESTO GARCIA D.D.S.

Provider Business Mailing Address
First Line	:	4125 - 26TH STREET APT. #6
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-1929
Country	:	US
Telephone Number	:	415-641-0917
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 NORTH EL DORADO STREET
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-5811
Country	:	US
Telephone Number	:	209-462-2452
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2008
Last Update Date	:	09/16/2008

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