Provider Demographics
NPI:1578782868
Name:GARCIA, JEANNIE BANEZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE BANEZ
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:BANEZ
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:617 N AZUSA AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-3504
Mailing Address - Country:US
Mailing Address - Phone:626-480-7777
Mailing Address - Fax:
Practice Address - Street 1:617 N AZUSA AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-3504
Practice Address - Country:US
Practice Address - Phone:626-480-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504371223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist