Provider Demographics
NPI:1629386065
Name:GARCIA, RAFAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E 5TH ST
Mailing Address - Street 2:APT. 2709
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4157
Mailing Address - Country:US
Mailing Address - Phone:512-745-3906
Mailing Address - Fax:
Practice Address - Street 1:1941 S IH 35 STE 107
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6169
Practice Address - Country:US
Practice Address - Phone:512-392-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25957122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist