Provider Demographics
NPI:1063628105
Name:GARCIA, LETICIA SUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:SUE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 HELENA AVE
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-4940
Mailing Address - Country:US
Mailing Address - Phone:409-727-1334
Mailing Address - Fax:
Practice Address - Street 1:1819 HELENA AVE
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-4940
Practice Address - Country:US
Practice Address - Phone:409-727-1334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131685122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist