Provider Demographics
NPI:1356820658
Name:ALIVIRI DENTAL GROUP INC.
Entity Type:Organization
Organization Name:ALIVIRI DENTAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-367-6740
Mailing Address - Street 1:1295 S LA BREA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-0972
Mailing Address - Country:US
Mailing Address - Phone:310-672-0129
Mailing Address - Fax:
Practice Address - Street 1:1295 S LA BREA AVE STE 101
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-0972
Practice Address - Country:US
Practice Address - Phone:310-672-0129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADDS39126OtherDENTAL BOARD OF CALIFORNIA