Provider Demographics
NPI:1003105628
Name:NIEVES, CARMEN GALEA (DDS)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:GALEA
Last Name:NIEVES
Suffix:
Gender:
Credentials:DDS
Other - Prefix:DR
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:GALEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:271 FT RICHARDSON AVE, BLDG 1001
Mailing Address - Street 2:
Mailing Address - City:GOODFELLOW AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76908
Mailing Address - Country:US
Mailing Address - Phone:325-654-3050
Mailing Address - Fax:
Practice Address - Street 1:271 FT RICHARDSON AVE, BLDG 1001
Practice Address - Street 2:
Practice Address - City:GOODFELLOW AFB
Practice Address - State:TX
Practice Address - Zip Code:76908
Practice Address - Country:US
Practice Address - Phone:325-654-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60654122300000X
FLDN30019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist