Provider Demographics
NPI:1447715453
Name:GARCIA, ROMAN MICHAEL (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:MICHAEL
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 RIVA RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-0831
Mailing Address - Country:US
Mailing Address - Phone:561-309-0269
Mailing Address - Fax:
Practice Address - Street 1:1600 GARTH BROOKS BLVD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6469
Practice Address - Country:US
Practice Address - Phone:405-578-5234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK79341223G0001X
OK1521223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice