Provider Demographics
NPI:1366678419
Name:ALVARADO, HUGO C (DDS)
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:C
Last Name:ALVARADO
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:P.O. BOX 962707
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3027
Mailing Address - Country:US
Mailing Address - Phone:915-855-8874
Mailing Address - Fax:915-921-7842
Practice Address - Street 1:831 AVENIDA JUAREZ
Practice Address - Street 2:
Practice Address - City:CD. JUAREZ, CHIH.
Practice Address - State:MX
Practice Address - Zip Code:32310
Practice Address - Country:MX
Practice Address - Phone:915-855-8874
Practice Address - Fax:915-921-7842
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ1061661223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000167579OtherTRICARE DENTAL PROGRAM