Basic Information
| Provider Information | |||||||||
| NPI: | 1225212558 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTERO | ||||||||
| FirstName: | TIARA | ||||||||
| MiddleName: | NAHIR | ||||||||
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| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | AA-11 RIO DUEY ST. | ||||||||
| Address2: | RIO HONDO 2 | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877840415 | ||||||||
| FaxNumber: | 7878554346 | ||||||||
| Practice Location | |||||||||
| Address1: | BETANCES ST. #38-B | ||||||||
| Address2: | |||||||||
| City: | VEGA BAJA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878553996 | ||||||||
| FaxNumber: | 7878554346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2007 | ||||||||
| LastUpdateDate: | 12/21/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 2777 | PR | Y | Dental Providers | Dentist | General Practice |
No ID Information.