Provider Demographics
NPI:1538188099
Name:GARCIA, RICHARD D (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:D
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1762 N WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-5130
Mailing Address - Country:US
Mailing Address - Phone:909-882-2032
Mailing Address - Fax:909-883-7428
Practice Address - Street 1:1762 N WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5130
Practice Address - Country:US
Practice Address - Phone:909-882-2032
Practice Address - Fax:909-883-7428
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice