Provider Demographics
NPI:1811494909
Name:GARCIA, NICHOLAS RAYMOND (DDS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:RAYMOND
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 1:172 LAFAYETTE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2059
Mailing Address - Country:US
Mailing Address - Phone:585-315-3261
Mailing Address - Fax:
Practice Address - Street 1:1859 LAKE RD
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:NY
Practice Address - Zip Code:14464-9527
Practice Address - Country:US
Practice Address - Phone:585-964-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0605181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program