Provider Demographics
NPI:1982922522
Name:DR. JEANNIE B. GARCIA DENTAL INC
Entity Type:Organization
Organization Name:DR. JEANNIE B. GARCIA DENTAL INC
Other - Org Name:BALDWIN PARK DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNIE BANEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:626-480-7777
Mailing Address - Street 1:4070 STERLING WAY
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-4223
Mailing Address - Country:US
Mailing Address - Phone:626-480-7777
Mailing Address - Fax:626-480-7775
Practice Address - Street 1:617 N AZUSA AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-3504
Practice Address - Country:US
Practice Address - Phone:626-332-4777
Practice Address - Fax:626-332-4781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50437122300000X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Multi-Specialty