MEDICARE: NICHOLAS R GARCIA FAMILY DENTISTRY PC

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	122300000X	Dentist	11147	MD

General Provider Information

NPI Number	:	1578879540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICHOLAS R GARCIA FAMILY DENTISTRY PC

Provider Business Mailing Address
First Line	:	36 S CHARLES ST
Second Line	:	STE 2202
City	:	BALTIMORE
State	:	MD
Zip	:	21201-3020
Country	:	US
Telephone Number	:	410-837-0304
Fax Number	:	410-837-0780

Provider Business Practice Location Address
First Line	:	36 S CHARLES ST
Second Line	:	STE 2202
City	:	BALTIMORE
State	:	MD
Zip	:	21201-3020
Country	:	US
Telephone Number	:	410-837-0304
Fax Number	:	410-837-0780

Authorized Official
Title or Position	:	CFO
Name	:	MRS. KATHARINE GARCIA
Credential	:
Telephone Number	:	410-837-0304

Provider Enumeration Date	:	08/27/2010
Last Update Date	:	08/27/2010

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