Provider Demographics
NPI:1285619528
Name:GARCIA, BOLIVAR ANTONIO (DDS)
Entity type:Individual
Prefix:DR
First Name:BOLIVAR
Middle Name:ANTONIO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:GALERIA MEDICA SUITE 202
Mailing Address - Street 2:SANTA CRUZ # 64
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7002
Mailing Address - Country:US
Mailing Address - Phone:787-787-2237
Mailing Address - Fax:787-778-1346
Practice Address - Street 1:GALERIA MEDICA SUITE 202
Practice Address - Street 2:SANTA CRUZ # 64
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7002
Practice Address - Country:US
Practice Address - Phone:787-787-2237
Practice Address - Fax:787-778-1346
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR20251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice