Provider Demographics
NPI:1265650873
Name:MARINO ALEA IGLESIAS, DDS CLINICA DENTAL
Entity Type:Organization
Organization Name:MARINO ALEA IGLESIAS, DDS CLINICA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARINO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEA IGLESIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-217-9185
Mailing Address - Street 1:32 MONTVALE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2633
Mailing Address - Country:US
Mailing Address - Phone:501-217-9185
Mailing Address - Fax:
Practice Address - Street 1:5209 W 65TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-3817
Practice Address - Country:US
Practice Address - Phone:501-565-7881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty