Active NPI
Miryam Nathalia Garcia, DDS
- Periodontics
- Alton, IL
National Provider Identifier
1104191881
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 136000125
- Practice address
- 2800 College Ave
Alton, IL 62002-4742 - Phone
- (618) 474-7208
- NPI assigned
- Mar 14, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 136000125 | IL | Primary |
Addresses
Primary practice location
2800 College Ave
Alton, IL 62002-4742
Mailing address
632 Amberwood LN
Ballwin, MO 63021-5888
Phone (314) 535-3289
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 136000125 | IL | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331683200000",
"number": "1104191881",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "632 AMBERWOOD LN",
"city": "BALLWIN",
"state": "MO",
"postal_code": "630215888",
"telephone_number": "314-535-3289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 COLLEGE AVE",
"city": "ALTON",
"state": "IL",
"postal_code": "620024742",
"telephone_number": "618-474-7208"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARCIA",
"first_name": "MIRYAM",
"middle_name": "NATHALIA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-14",
"last_updated": "2012-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IL",
"license": "136000125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.