Provider Demographics
NPI:1407144850
Name:TOVAR, CARLY MICHELE (DDS)
Entity type:Individual
Prefix:DR
First Name:CARLY
Middle Name:MICHELE
Last Name:TOVAR
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 1:13205 GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3018
Mailing Address - Country:US
Mailing Address - Phone:210-767-3562
Mailing Address - Fax:
Practice Address - Street 1:13205 GEORGE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3018
Practice Address - Country:US
Practice Address - Phone:210-767-3562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27004122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX297927003Medicaid
TX280763YK73Medicare PIN