Ivanca Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2777 Issued in PR

Legal business name

IVANCA DENTAL LLC

Practice address

38-B Calle Betances
Vega Baja, PR 00693-4453

Phone

(787) 855-3996

Fax

(787) 855-3996

NPI assigned

Aug 29, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Tiara Nahir Otero, D.M.D.

Title

Dentist

Phone

(787) 855-3996

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377734400000",
    "number": "1366876096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38-B CALLE BETANCES",
            "city": "VEGA BAJA",
            "state": "PR",
            "postal_code": "006934453",
            "telephone_number": "787-855-3996",
            "fax_number": "787-855-3996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38-B CALLE BETANCES",
            "city": "VEGA BAJA",
            "state": "PR",
            "postal_code": "006934453",
            "telephone_number": "787-855-3996",
            "fax_number": "787-855-3996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVANCA DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-29",
        "last_updated": "2013-08-29",
        "status": "A",
        "authorized_official_last_name": "OTERO",
        "authorized_official_first_name": "TIARA",
        "authorized_official_middle_name": "NAHIR",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "787-855-3996",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "PR",
            "license": "2777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Vega Baja, PR
• Providers in Vega Baja, PR by specialty
• General Practice Dentistry in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.