Provider Demographics
NPI:1083144083
Name:NARAVANE, TANYA (DMD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:NARAVANE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2189 CLEVELAND STREET
Mailing Address - Street 2:#252
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3243
Mailing Address - Country:US
Mailing Address - Phone:727-461-9149
Mailing Address - Fax:
Practice Address - Street 1:5215 MANATEE AVE. W.
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3742
Practice Address - Country:US
Practice Address - Phone:941-792-7887
Practice Address - Fax:941-624-2208
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN227101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice