Provider Demographics
NPI:1225212558
Name:OTERO, TIARA NAHIR (DMD)
Entity Type:Individual
Prefix:
First Name:TIARA
Middle Name:NAHIR
Last Name:OTERO
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:AA-11 RIO DUEY ST.
Mailing Address - Street 2:RIO HONDO 2
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-784-0415
Mailing Address - Fax:787-855-4346
Practice Address - Street 1:BETANCES ST. #38-B
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-855-3996
Practice Address - Fax:787-855-4346
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice