MEDICARE: DR. ALFREDO GARCIA JR. 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	1223G0001X	General Practice Dentistry	7418	OK

General Provider Information

NPI Number	:	1578130910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFREDO GARCIA JR. DDS

Provider Business Mailing Address
First Line	:	2828 NW 30TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7404
Country	:	US
Telephone Number	:	405-381-8109
Fax Number	:

Provider Business Practice Location Address
First Line	:	2828 NW 30TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7404
Country	:	US
Telephone Number	:	405-381-8109
Fax Number	:

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

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	06/04/2021

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