Provider Demographics
NPI:1649882523
Name:TAMARGO ECHEVERRIA, IVIS (DMD)
Entity type:Individual
Prefix:
First Name:IVIS
Middle Name:
Last Name:TAMARGO ECHEVERRIA
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 1:15105 SW 31ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4904
Mailing Address - Country:US
Mailing Address - Phone:786-413-7165
Mailing Address - Fax:
Practice Address - Street 1:15105 SW 31ST TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4904
Practice Address - Country:US
Practice Address - Phone:786-413-7165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25410122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist