Provider Demographics
NPI:1134343171
Name:GARCIA, NICHOLAS R (DDS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:R
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:NICHOLAS
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:36 S CHARLES ST
Mailing Address - Street 2:SUITE#2202
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-3020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36 S CHARLES ST
Practice Address - Street 2:SUITE#2202
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3020
Practice Address - Country:US
Practice Address - Phone:410-837-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice