Provider Demographics
NPI:1982607305
Name:GARCIA, RAUL ISIDRO (DMD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:ISIDRO
Last Name:GARCIA
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 1:107 CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-3017
Mailing Address - Country:US
Mailing Address - Phone:781-235-0105
Mailing Address - Fax:
Practice Address - Street 1:107 CLIFF RD
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-3017
Practice Address - Country:US
Practice Address - Phone:781-235-0105
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA148861223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics