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General NPI Number Information
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NPI Number | 1174546824
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Entity Type | Individual
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Provider Name | CARLOS ANDRES NIEVES SR. DMD
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 04/25/2020
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Provider Practice Location Address
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Address Line | 4126 INDEPENDENT DR
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City | MARIANNA
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State | FL
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Zip | 32448-4023
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Country | US
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Telephone | 850-394-4907
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Fax |
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Provider Business Mailing Address
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Address Line | 403 E 11TH ST
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City | PANAMA CITY
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State | FL
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Zip | 32401-3409
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Country | US
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Telephone | 850-747-5599
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1689
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN22532
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License Number State | FL
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