Provider Demographics
NPI:1942407929
Name:GARCIA, NATIVIDAD (DDS)
Entity Type:Individual
Prefix:
First Name:NATIVIDAD
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MORRELL PL
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-1221
Mailing Address - Country:US
Mailing Address - Phone:973-478-3327
Mailing Address - Fax:212-304-1847
Practice Address - Street 1:4501 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-2409
Practice Address - Country:US
Practice Address - Phone:212-304-2229
Practice Address - Fax:212-304-1847
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0481321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02039678Medicaid