Provider Demographics
NPI:1346239589
Name:ALVAREZ, JESUS MANUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:MANUEL
Last Name:ALVAREZ
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 1:2400 HUGHES AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-6109
Mailing Address - Country:US
Mailing Address - Phone:718-295-1615
Mailing Address - Fax:718-295-1616
Practice Address - Street 1:2400 HUGHES AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-6109
Practice Address - Country:US
Practice Address - Phone:718-295-1615
Practice Address - Fax:718-295-1616
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050723122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02439710Medicaid