Provider Demographics
NPI:1164806543
Name:ALVIN VASQUEZ
Entity Type:Organization
Organization Name:ALVIN VASQUEZ
Other - Org Name:AV DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENSIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-375-2622
Mailing Address - Street 1:840 N NORMA ST STE A
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3570
Mailing Address - Country:US
Mailing Address - Phone:760-375-2622
Mailing Address - Fax:760-994-1345
Practice Address - Street 1:840 N NORMA ST STE A
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3570
Practice Address - Country:US
Practice Address - Phone:760-375-2622
Practice Address - Fax:760-994-1345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA426221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty