Provider Demographics
NPI:1255834925
Name:ALVI, SHAN
Entity Type:Individual
Prefix:DR
First Name:SHAN
Middle Name:
Last Name:ALVI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5114 MEDICAL DR APT 2205
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3870
Mailing Address - Country:US
Mailing Address - Phone:617-608-8660
Mailing Address - Fax:
Practice Address - Street 1:9163 FM 78
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-2147
Practice Address - Country:US
Practice Address - Phone:210-971-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist