Provider Demographics
NPI:1144219841
Name:GARCIA, GERTRUDIS (DMD)
Entity Type:Individual
Prefix:
First Name:GERTRUDIS
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 BERGEN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4404
Mailing Address - Country:US
Mailing Address - Phone:201-946-1000
Mailing Address - Fax:201-946-1641
Practice Address - Street 1:846 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4404
Practice Address - Country:US
Practice Address - Phone:201-946-1000
Practice Address - Fax:201-946-1641
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ190661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6430309Medicaid