Provider Demographics
NPI:1073789822
Name:GARCIA, MARIELLA TATIANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIELLA
Middle Name:TATIANA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 CEDAR ST
Mailing Address - Street 2:UNIT 1002
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-4100
Mailing Address - Country:US
Mailing Address - Phone:206-599-9466
Mailing Address - Fax:206-543-0063
Practice Address - Street 1:6222 NE 74TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8158
Practice Address - Country:US
Practice Address - Phone:206-543-5800
Practice Address - Fax:206-543-0063
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000103561223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry