Provider Demographics
NPI:1669638029
Name:JUAN GARCIA GARCIA MEDICAL ART
Entity Type:Organization
Organization Name:JUAN GARCIA GARCIA MEDICAL ART
Other - Org Name:FACIAL PROSTHETICS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA, CCA
Authorized Official - Phone:410-963-5585
Mailing Address - Street 1:31 HADDINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5720
Mailing Address - Country:US
Mailing Address - Phone:410-963-5585
Mailing Address - Fax:410-321-0023
Practice Address - Street 1:10310 S DOLFIELD RD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3558
Practice Address - Country:US
Practice Address - Phone:410-356-7839
Practice Address - Fax:410-998-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5271320002Medicare NSC