Provider Demographics
NPI:1275840555
Name:GARCIA, MAURICIO (DDS)
Entity Type:Individual
Prefix:
First Name:MAURICIO
Middle Name:
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 1:21 FORT EVANS RD NE
Mailing Address - Street 2:SUITE E
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-5079
Mailing Address - Country:US
Mailing Address - Phone:703-777-7307
Mailing Address - Fax:703-777-1840
Practice Address - Street 1:21 FORT EVANS RD NE
Practice Address - Street 2:SUITE E
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5079
Practice Address - Country:US
Practice Address - Phone:703-777-7307
Practice Address - Fax:703-777-1840
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413936122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist