Provider Demographics
NPI:1093414609
Name:R. MICHAEL ALVAREZ, DDS, INC.
Entity Type:Organization
Organization Name:R. MICHAEL ALVAREZ, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-713-6790
Mailing Address - Street 1:2188 PERALTA BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-3941
Mailing Address - Country:US
Mailing Address - Phone:510-713-6790
Mailing Address - Fax:510-713-6794
Practice Address - Street 1:2188 PERALTA BLVD STE D
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-3941
Practice Address - Country:US
Practice Address - Phone:510-713-6790
Practice Address - Fax:510-713-6794
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:R. MICHAEL ALVAREZ, DDS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X2210XDental ProvidersDentistOrofacial PainGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154461150OtherDDS