Provider Demographics
NPI:1376856609
Name:ROVIRA, FANNY ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:FANNY
Middle Name:ELIZABETH
Last Name:ROVIRA
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 1:750 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-1014
Mailing Address - Country:US
Mailing Address - Phone:727-687-4949
Mailing Address - Fax:
Practice Address - Street 1:4333 W BAY TO BAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-6606
Practice Address - Country:US
Practice Address - Phone:813-837-5147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL129531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice