Provider Demographics
NPI:1285832907
Name:GARCIA, JAVIER
Entity type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6343 EASTERN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-1605
Mailing Address - Country:US
Mailing Address - Phone:323-562-4891
Mailing Address - Fax:323-562-4898
Practice Address - Street 1:6343 EASTERN AVE STE B
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-1605
Practice Address - Country:US
Practice Address - Phone:323-562-4891
Practice Address - Fax:323-562-4898
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice