Provider Demographics
NPI:1639485501
Name:GARCIA, VICTOR CORELLA (RDH)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:CORELLA
Last Name:GARCIA
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 W INA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2110
Mailing Address - Country:US
Mailing Address - Phone:520-742-9500
Mailing Address - Fax:520-877-9800
Practice Address - Street 1:2934 W INA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2110
Practice Address - Country:US
Practice Address - Phone:520-742-9500
Practice Address - Fax:520-877-9800
Is Sole Proprietor?:No
Enumeration Date:2010-08-29
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD2651124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist