Provider Demographics
NPI:1871599514
Name:TABOAS, YIRA VIONET (DDS)
Entity type:Individual
Prefix:DR
First Name:YIRA
Middle Name:VIONET
Last Name:TABOAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-0395
Mailing Address - Country:US
Mailing Address - Phone:787-862-4626
Mailing Address - Fax:787-862-4626
Practice Address - Street 1:26 AVE BUENA VISTA
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687
Practice Address - Country:US
Practice Address - Phone:787-862-4626
Practice Address - Fax:787-862-4626
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8338OtherINTERNATIONAL MEDICAL CAR
PR3511103OtherACAA
PR851910OtherUNITED CONCORDIA
PR41601OtherTRIPLE-S
PR041365OtherLA CRUZ AZUL
PR61727OtherMEDICAL CARD SYSTEM