Richard Douglas Taverna, PH.D.,D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

13696 Issued in TX

Practice address

430 W Loop 1604 N
Suite 109
San Antonio, TX 78251-3342

Phone

(210) 469-3869

Fax

(210) 402-0025

NPI assigned

Jun 21, 2005

Reactivated

Mar 28, 2006

Last updated

Sep 12, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347408000000",
    "number": "1912903444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 W.LOOP 1604 NORTH, SUITE 109",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78251",
            "telephone_number": "210-647-7447",
            "fax_number": "210-647-7839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 W LOOP 1604 N",
            "address_2": "SUITE 109",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782513342",
            "telephone_number": "210-469-3869",
            "fax_number": "210-402-0025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVERNA",
        "first_name": "RICHARD",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "PH.D.,D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2012-09-12",
        "deactivation_date": "2006-03-21",
        "reactivation_date": "2006-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "13696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda B Tavel, LCDC
• Michelle Tavera, MD
• Robert Anthony Tavera, MD
• Karina Taveras
• Josephine Amalia Taverna, M.D.
• Justine T Tavitas
• Christina Tavizon
• Ehab F Tawadrous, RN
• Sylvia Habib Tawadrous, RN, CCRN
• Johanna Tawfik, FNP-C

• General Practice Dentistry in San Antonio, TX
• Providers in San Antonio, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2012; 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.