MEDICARE: DR. MARIELLA TATIANA GARCIA DDS

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	1223P0221X	Pediatric Dentistry	DE00010356	WA

General Provider Information

NPI Number	:	1073789822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIELLA TATIANA GARCIA DDS

Provider Business Mailing Address
First Line	:	76 CEDAR ST
Second Line	:	UNIT 1002
City	:	SEATTLE
State	:	WA
Zip	:	98121-4100
Country	:	US
Telephone Number	:	206-599-9466
Fax Number	:	206-543-0063

Provider Business Practice Location Address
First Line	:	6222 NE 74TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-8158
Country	:	US
Telephone Number	:	206-543-5800
Fax Number	:	206-543-0063

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

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	01/10/2013

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