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General NPI Number Information
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NPI Number | 1225212558
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Entity Type | Individual
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Provider Name | TIARA NAHIR OTERO D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | BETANCES ST. #38-B
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City | VEGA BAJA
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State | PR
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Zip | 00693
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Country | US
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Telephone | 787-855-3996
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Fax | 787-855-4346
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Provider Business Mailing Address
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Address Line | AA-11 RIO DUEY ST. RIO HONDO 2
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City | BAYAMON
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State | PR
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Zip | 00961
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Country | US
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Telephone | 787-784-0415
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Fax | 787-855-4346
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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 | 2777
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License Number State | PR
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