Provider Demographics
NPI:1063674281
Name:GARCIA, JESSICA G (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:G
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 1:750 COYOTE TRL
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4004
Mailing Address - Country:US
Mailing Address - Phone:361-668-3384
Mailing Address - Fax:361-668-6191
Practice Address - Street 1:750 COYOTE TRL
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4004
Practice Address - Country:US
Practice Address - Phone:361-668-3384
Practice Address - Fax:361-668-6191
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-29
Last Update Date:2008-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24092122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist