Provider Demographics
NPI:1609401942
Name:INNOVARE DENTAL
Entity Type:Organization
Organization Name:INNOVARE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:DENISSE
Authorized Official - Last Name:GONZALEZ FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-690-2460
Mailing Address - Street 1:EDIF TROPICAL PLAZA SUITE 3
Mailing Address - Street 2:CARR 2 MARGINAL 272
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659
Mailing Address - Country:US
Mailing Address - Phone:787-690-2460
Mailing Address - Fax:
Practice Address - Street 1:EDIF TROPICAL PLAZA SUITE 3
Practice Address - Street 2:CARR 2 MARGINAL 272
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-690-2460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental