Provider Demographics
NPI:1508636812
Name:GARCIA, MICHELLE PATRICIA (DDS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PATRICIA
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 1:1701 NEIL ARMSTRONG ST APT 204
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-1929
Mailing Address - Country:US
Mailing Address - Phone:760-619-0146
Mailing Address - Fax:
Practice Address - Street 1:1451 N MONTEBELLO BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2584
Practice Address - Country:US
Practice Address - Phone:626-606-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109433122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist