Provider Demographics
NPI:1447616990
Name:GARCIA, MONIQUE MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:MARIE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15603 LEGEND SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5563
Mailing Address - Country:US
Mailing Address - Phone:210-490-8300
Mailing Address - Fax:
Practice Address - Street 1:203 N LOOP 1604 W
Practice Address - Street 2:UNIT 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1027
Practice Address - Country:US
Practice Address - Phone:210-490-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31592122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist