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General NPI Number Information
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NPI Number | 1598979122
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Entity Type | Organization
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Legal Business Name | CARLA TALAVERA-JORDAN D.M.D., P.A.
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 11/26/2011
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Provider Practice Location Address
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Address Line | 533 CAGAN PARK AVE SUITE 307
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City | CLERMONT
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State | FL
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Zip | 34714
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Country | US
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Telephone | 352-242-0912
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Fax | 352-242-2712
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Provider Business Mailing Address
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Address Line | 533 CAGAN PARK AVE SUITE 307
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City | CLERMONT
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State | FL
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Zip | 34714-4867
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Country | US
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Telephone | 352-242-0912
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARLA PATRICIA TALAVERA-JORDAN
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Credential | D.M.D.
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Telephone | 352-242-0912
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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 | DN 16454
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License Number State | FL
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