Provider Demographics
NPI:1417299686
Name:MACIAS, TANIA MARIA (DMD)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:MARIA
Last Name:MACIAS
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 1:600 BLVD DE LA MONTANA APT 427
Mailing Address - Street 2:URB. ARBOLES DE MONTEHIEDRA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7120
Mailing Address - Country:US
Mailing Address - Phone:787-525-1500
Mailing Address - Fax:
Practice Address - Street 1:600 BLVD DE LA MONTANA APT 427
Practice Address - Street 2:URB. ARBOLES DE MONTEHIEDRA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7120
Practice Address - Country:US
Practice Address - Phone:787-525-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist