Provider Demographics
NPI:1437603800
Name:TAVAREZ, LOURDES FABIOLA (DDS)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:FABIOLA
Last Name:TAVAREZ
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 1:725 N TOWER RD STE A
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-3762
Mailing Address - Country:US
Mailing Address - Phone:956-787-4337
Mailing Address - Fax:956-787-0200
Practice Address - Street 1:725 N TOWER RD STE A
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-3762
Practice Address - Country:US
Practice Address - Phone:956-787-4337
Practice Address - Fax:956-787-0200
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32196122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice