Provider Demographics
NPI:1295857910
Name:ALLA FUCHS DDS A PROF CORP
Entity Type:Organization
Organization Name:ALLA FUCHS DDS A PROF CORP
Other - Org Name:DBA LEMON GROVE FAMILY DENTAL CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUCHS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-464-2944
Mailing Address - Street 1:7441 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1603
Mailing Address - Country:US
Mailing Address - Phone:619-464-2944
Mailing Address - Fax:619-464-2952
Practice Address - Street 1:7441 BROADWAY
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1603
Practice Address - Country:US
Practice Address - Phone:619-464-2944
Practice Address - Fax:619-464-2952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3113101OtherMEDI CAL