Provider Demographics
NPI:1598190852
Name:TAVERAS, MYRIAM BELLORIN (DMD)
Entity type:Individual
Prefix:
First Name:MYRIAM
Middle Name:BELLORIN
Last Name:TAVERAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 PALERMO DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1906
Mailing Address - Country:US
Mailing Address - Phone:407-697-6633
Mailing Address - Fax:
Practice Address - Street 1:1607 PELERMO DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327
Practice Address - Country:US
Practice Address - Phone:407-692-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist