Provider Demographics
NPI:1912703653
Name:MAVARES RODRIGUEZ, ELIANYS YOSELI (DMD)
Entity type:Individual
Prefix:
First Name:ELIANYS
Middle Name:YOSELI
Last Name:MAVARES RODRIGUEZ
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 1:1890 N BROAD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-3657
Mailing Address - Country:US
Mailing Address - Phone:919-586-8565
Mailing Address - Fax:
Practice Address - Street 1:1890 N BROAD ST STE 100
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-3657
Practice Address - Country:US
Practice Address - Phone:919-295-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC145041223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223G0001XDental ProvidersDentistGeneral Practice