Provider Demographics
NPI:1750734877
Name:POVEDA, INGRID CAROLINA (X2)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:CAROLINA
Last Name:POVEDA
Suffix:
Gender:F
Credentials:X2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WIESBADEN DENTAL CLINIC
Mailing Address - Street 2:UNIT 24320 BOX 0042
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09005-4320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WIESBADEN DENTAL CLINIC
Practice Address - Street 2:FLUGPLATZ ERBENHEIM BLDG 1040
Practice Address - City:WIESBADEN
Practice Address - State:HESSEN
Practice Address - Zip Code:65205
Practice Address - Country:DE
Practice Address - Phone:063719-464-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist