Provider Demographics
NPI:1114028719
Name:GARCIA, RICHARD JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOHN
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 REDWOOD HIGHWAY
Mailing Address - Street 2:STE 367
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941
Mailing Address - Country:US
Mailing Address - Phone:415-383-2256
Mailing Address - Fax:415-383-2264
Practice Address - Street 1:655 REDWOOD HIGHWAY
Practice Address - Street 2:STE 367
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941
Practice Address - Country:US
Practice Address - Phone:415-383-2256
Practice Address - Fax:415-383-2264
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24976122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist