Provider Demographics
NPI:1902488174
Name:TOVAR, JEAN LOUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:LOUIS
Last Name:TOVAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:TOVAR CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:8560 SW 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4555
Mailing Address - Country:US
Mailing Address - Phone:305-497-9345
Mailing Address - Fax:
Practice Address - Street 1:2555 COLLINS AVE STE C3
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4723
Practice Address - Country:US
Practice Address - Phone:305-672-9698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN284001223G0001X
CT13113390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223G0001XDental ProvidersDentistGeneral Practice