Provider Demographics
NPI:1235807819
Name:ALVAREZ RODRIGUEZ, GRETEL VIVIANA (DDS)
Entity Type:Individual
Prefix:
First Name:GRETEL
Middle Name:VIVIANA
Last Name:ALVAREZ RODRIGUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13120 SW 92ND AVE APT B-417
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-5713
Mailing Address - Country:US
Mailing Address - Phone:786-367-5449
Mailing Address - Fax:
Practice Address - Street 1:1250 SW 27TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4748
Practice Address - Country:US
Practice Address - Phone:323-712-0348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26234122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist