Provider Demographics
NPI:1740614163
Name:GARCIA, LUISA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUISA
Middle Name:M
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10794 PINES BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3920
Mailing Address - Country:US
Mailing Address - Phone:954-432-1607
Mailing Address - Fax:
Practice Address - Street 1:10794 PINES BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3920
Practice Address - Country:US
Practice Address - Phone:954-432-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN210061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice