Provider Demographics
NPI:1528623154
Name:TOVAR, NICKY MARTIN
Entity type:Individual
Prefix:
First Name:NICKY
Middle Name:MARTIN
Last Name:TOVAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3695 W BOYNTON BEACH BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4516
Mailing Address - Country:US
Mailing Address - Phone:561-364-1800
Mailing Address - Fax:561-364-1906
Practice Address - Street 1:3695 W BOYNTON BEACH BLVD STE 1
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4516
Practice Address - Country:US
Practice Address - Phone:561-364-1800
Practice Address - Fax:561-364-1906
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN294911223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery