Provider Demographics
NPI:1659493500
Name:TAVERAS, SONIA DIGNORA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SONIA
Middle Name:DIGNORA
Last Name:TAVERAS
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 1:325 NORTHWEST 119 AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182
Mailing Address - Country:US
Mailing Address - Phone:305-226-8531
Mailing Address - Fax:
Practice Address - Street 1:7892 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2304
Practice Address - Country:US
Practice Address - Phone:305-261-8608
Practice Address - Fax:305-261-7608
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL073920101Medicaid