Provider Demographics
NPI:1366834517
Name:ALPHA DENTAL
Entity Type:Organization
Organization Name:ALPHA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUNAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-980-6310
Mailing Address - Street 1:9897 LAKE WORTH RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2375
Mailing Address - Country:US
Mailing Address - Phone:954-980-6310
Mailing Address - Fax:
Practice Address - Street 1:9897 LAKE WORTH RD
Practice Address - Street 2:SUITE 108
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2375
Practice Address - Country:US
Practice Address - Phone:954-980-6310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty