Provider Demographics
NPI:1144742792
Name:FRANCO TAVERAS, LUZ NATALIA (DDS)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:NATALIA
Last Name:FRANCO TAVERAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 W MCNAB RD STE 115
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-5329
Mailing Address - Country:US
Mailing Address - Phone:354-856-5042
Mailing Address - Fax:
Practice Address - Street 1:7300 W MCNAB RD STE 115
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321
Practice Address - Country:US
Practice Address - Phone:954-722-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22829122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023279700Medicaid
FLDN22829OtherFLORIDA DENTAL LICENSE