Provider Demographics
NPI:1942308366
Name:POVEDA, CONSUELO TRINIDAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CONSUELO
Middle Name:TRINIDAD
Last Name:POVEDA
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 1:3742 90TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7830
Mailing Address - Country:US
Mailing Address - Phone:718-424-5559
Mailing Address - Fax:718-426-2428
Practice Address - Street 1:3721 75TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6405
Practice Address - Country:US
Practice Address - Phone:718-476-3800
Practice Address - Fax:718-533-7808
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045030-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist