Provider Demographics
NPI:1164757811
Name:ALEXANDER DURAN DENTAL CORPOTATION
Entity Type:Organization
Organization Name:ALEXANDER DURAN DENTAL CORPOTATION
Other - Org Name:DENTAL HEAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-944-7410
Mailing Address - Street 1:9267 HAVEN AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5430
Mailing Address - Country:US
Mailing Address - Phone:909-944-7410
Mailing Address - Fax:909-944-7420
Practice Address - Street 1:9267 HAVEN AVE STE 160
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5430
Practice Address - Country:US
Practice Address - Phone:909-944-7410
Practice Address - Fax:909-944-7420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty