1982922522 NPI number — DR. JEANNIE B. GARCIA DENTAL INC

Table of content: (NPI 1982922522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982922522 NPI number — DR. JEANNIE B. GARCIA DENTAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. JEANNIE B. GARCIA DENTAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BALDWIN PARK DENTAL OFFICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982922522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4070 STERLING WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALDWIN PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91706-4223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-480-7777
Provider Business Mailing Address Fax Number:
626-480-7775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
617 N AZUSA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91722-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-332-4777
Provider Business Practice Location Address Fax Number:
626-332-4781
Provider Enumeration Date:
05/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
JEANNIE BANEZ
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
626-480-7777

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  50437 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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