Provider Demographics
NPI:1518097278
Name:GARCIA-IBANCOVICHI, MARIA ELBA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ELBA
Last Name:GARCIA-IBANCOVICHI
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 1:618 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4724
Mailing Address - Country:US
Mailing Address - Phone:214-946-2277
Mailing Address - Fax:214-941-6068
Practice Address - Street 1:618 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4724
Practice Address - Country:US
Practice Address - Phone:214-946-2277
Practice Address - Fax:214-941-6068
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB16354-01OtherDELTA DENTAL GOV. PROGRAMS
TX1614067-01Medicaid