Provider Demographics
NPI:1770192668
Name:GARCIA, MARCO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCO
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 1:2550 S TAYLOR PL
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-6063
Mailing Address - Country:US
Mailing Address - Phone:909-319-8715
Mailing Address - Fax:
Practice Address - Street 1:1000 SKYLINE BLVD
Practice Address - Street 2:
Practice Address - City:AVENAL
Practice Address - State:CA
Practice Address - Zip Code:93204-1850
Practice Address - Country:US
Practice Address - Phone:559-386-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1050821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice