Provider Demographics
NPI:1295748747
Name:TALAVERA-JORDAN, CARLA PATRICIA (DMD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:PATRICIA
Last Name:TALAVERA-JORDAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12963 OVERSTREET RD
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6643
Mailing Address - Country:US
Mailing Address - Phone:407-574-7370
Mailing Address - Fax:407-574-7370
Practice Address - Street 1:12963 OVERSTREET RD
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6643
Practice Address - Country:US
Practice Address - Phone:407-574-7370
Practice Address - Fax:407-574-7370
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 16454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist