Provider Demographics
NPI:1033376470
Name:ALANIS DENTAL CENTER, PA
Entity Type:Organization
Organization Name:ALANIS DENTAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:ALANIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-787-3317
Mailing Address - Street 1:109 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-2541
Mailing Address - Country:US
Mailing Address - Phone:956-787-3317
Mailing Address - Fax:956-787-0069
Practice Address - Street 1:109 S 6TH ST
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2541
Practice Address - Country:US
Practice Address - Phone:956-787-3317
Practice Address - Fax:956-787-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111159301Medicaid
TXG60172-01OtherCHIP