Individual
DR. ANDRE ELIAS GARCIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3355 W PRATT AVE, LINCOLNWOOD, IL 60712-3828
(224) 522-8484
Mailing address
3355 W PRATT AVE, LINCOLNWOOD, IL 60712-3828
(224) 522-8484
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019030360
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019030360
LICENSE NUMBER
IL
01
—
319019588
CONTROLLED SUBSTANCE LICENSE
IL
Enumeration date
07/29/2015
Last updated
07/29/2015
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