Provider Demographics
NPI:1942446729
Name:TALAVERA, JOSE ANDRES (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANDRES
Last Name:TALAVERA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8341 NW 169TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6690
Mailing Address - Country:US
Mailing Address - Phone:305-558-8144
Mailing Address - Fax:305-558-8145
Practice Address - Street 1:17660 NW 78TH AVE
Practice Address - Street 2:STE 105
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3662
Practice Address - Country:US
Practice Address - Phone:305-558-8144
Practice Address - Fax:305-558-8145
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-27
Last Update Date:2008-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 153291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice