Provider Demographics
NPI:1528591831
Name:NAVASERO, AVA
Entity Type:Individual
Prefix:MISS
First Name:AVA
Middle Name:
Last Name:NAVASERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WATERSIDE PLZ
Mailing Address - Street 2:9C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2612
Mailing Address - Country:US
Mailing Address - Phone:774-312-3886
Mailing Address - Fax:
Practice Address - Street 1:20 WATERSIDE PLZ
Practice Address - Street 2:9C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2612
Practice Address - Country:US
Practice Address - Phone:774-312-3886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1026571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice