Provider Demographics
NPI:1164847729
Name:ALBELAIS DENTAL CORPORATION
Entity Type:Organization
Organization Name:ALBELAIS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTREBERTO
Authorized Official - Middle Name:BOIDO
Authorized Official - Last Name:ALBELAIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-281-1880
Mailing Address - Street 1:1037 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4710
Mailing Address - Country:US
Mailing Address - Phone:626-281-1880
Mailing Address - Fax:626-281-2782
Practice Address - Street 1:1037 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4710
Practice Address - Country:US
Practice Address - Phone:626-281-1880
Practice Address - Fax:626-281-2782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23881305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization