Provider Demographics
NPI:1326500166
Name:BABU, ALVIN MUNDACKAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:MUNDACKAL
Last Name:BABU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8791 ALTA DR STE 1036
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8569
Mailing Address - Country:US
Mailing Address - Phone:347-952-5205
Mailing Address - Fax:
Practice Address - Street 1:9085 W POST RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2415
Practice Address - Country:US
Practice Address - Phone:702-706-8865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0612211223G0001X, 122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program