Provider Demographics
NPI:1942211719
Name:GARCIA, RAUL ISAAC (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:ISAAC
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 SW 56TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-6559
Mailing Address - Country:US
Mailing Address - Phone:305-595-4616
Mailing Address - Fax:305-595-4927
Practice Address - Street 1:9301 SW 56TH ST STE A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-6559
Practice Address - Country:US
Practice Address - Phone:305-595-4616
Practice Address - Fax:305-595-4927
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14125122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist