Provider Demographics
NPI:1427194851
Name:GARCIA, JUAN CARLOS (DMD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
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 1:1805 MCLEARY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911
Mailing Address - Country:US
Mailing Address - Phone:787-792-6953
Mailing Address - Fax:787-775-0766
Practice Address - Street 1:MEDITACION ST
Practice Address - Street 2:#55 CENTRO SERUICIOS MEDICOS OFIC 1B
Practice Address - City:MAYAQUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-6699
Practice Address - Fax:787-833-6675
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR41395Medicare ID - Type Unspecified
U05541Medicare UPIN