Provider Demographics
NPI:1952148082
Name:BEDOYA, MANUEL GARCIA (DMD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:GARCIA
Last Name:BEDOYA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26586
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85726-6586
Mailing Address - Country:US
Mailing Address - Phone:520-573-1900
Mailing Address - Fax:520-573-1424
Practice Address - Street 1:4001 S MISSON RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746
Practice Address - Country:US
Practice Address - Phone:520-573-1900
Practice Address - Fax:520-573-1424
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDO121861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice