Provider Demographics
NPI:1023239639
Name:GARCIA, DANIEL CARLOS (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CARLOS
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:N54W6135 MILL STREET
Mailing Address - Street 2:STE 900
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012
Mailing Address - Country:US
Mailing Address - Phone:262-375-8888
Mailing Address - Fax:262-375-8255
Practice Address - Street 1:N54W6135 MILL STREET
Practice Address - Street 2:STE 900
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012
Practice Address - Country:US
Practice Address - Phone:262-375-8888
Practice Address - Fax:262-375-8255
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist