Provider Demographics
NPI:1740681451
Name:EGHAREVBA, PAULA (DDS)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:
Last Name:EGHAREVBA
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 1:15769 SW 140TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-6714
Mailing Address - Country:US
Mailing Address - Phone:773-398-8818
Mailing Address - Fax:
Practice Address - Street 1:1440 NW NORTH RIVER DR STE 345
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2894
Practice Address - Country:US
Practice Address - Phone:786-353-9887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31176122300000X
FL245471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist