Provider Demographics
NPI:1144231812
Name:GARCIA, LUIS MANUEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:MANUEL
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 CALLE HONDURAS APT 2101
Mailing Address - Street 2:PLAZA DEL REY
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-2814
Mailing Address - Country:US
Mailing Address - Phone:787-763-1651
Mailing Address - Fax:787-764-0606
Practice Address - Street 1:511 AVE HOSTOS
Practice Address - Street 2:SUITE A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3230
Practice Address - Country:US
Practice Address - Phone:787-754-9585
Practice Address - Fax:787-274-1385
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice