Provider Demographics
NPI:1245334713
Name:MARY ROSE GARCIA DMD INC
Entity type:Organization
Organization Name:MARY ROSE GARCIA DMD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ROSE
Authorized Official - Middle Name:VENTURA
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-551-1601
Mailing Address - Street 1:1601 EL CAMINO REAL
Mailing Address - Street 2:STE 305
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002
Mailing Address - Country:US
Mailing Address - Phone:650-651-1601
Mailing Address - Fax:650-551-1611
Practice Address - Street 1:1601 EL CAMINO REAL
Practice Address - Street 2:STE 305
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002
Practice Address - Country:US
Practice Address - Phone:650-651-1601
Practice Address - Fax:650-551-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40593122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty