Provider Demographics
NPI:1811515182
Name:KAYLA TAVARES, DDS, PLLC
Entity type:Organization
Organization Name:KAYLA TAVARES, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVARES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDS
Authorized Official - Phone:205-745-0942
Mailing Address - Street 1:104 DIABLO DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-6591
Mailing Address - Country:US
Mailing Address - Phone:205-745-0942
Mailing Address - Fax:
Practice Address - Street 1:5540 SYCAMORE SCHOOL RD STE 336
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-3061
Practice Address - Country:US
Practice Address - Phone:817-591-0336
Practice Address - Fax:817-591-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty