Provider Demographics
NPI:1174669394
Name:TOVAR, MAURICIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAURICIO
Middle Name:
Last Name:TOVAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-6342
Mailing Address - Country:US
Mailing Address - Phone:713-802-0044
Mailing Address - Fax:713-802-2162
Practice Address - Street 1:2515 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-6342
Practice Address - Country:US
Practice Address - Phone:713-802-0044
Practice Address - Fax:713-802-2162
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX170001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160126201Medicaid
TX090792502Medicaid