Provider Demographics
NPI:1225201734
Name:GARCIA, JUAN DE DIOS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUAN DE DIOS
Middle Name:
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 1:7769 NW 146TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1559
Mailing Address - Country:US
Mailing Address - Phone:305-821-4777
Mailing Address - Fax:305-821-4753
Practice Address - Street 1:7769 NW 146TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1559
Practice Address - Country:US
Practice Address - Phone:305-821-4777
Practice Address - Fax:305-821-4753
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN108601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics