Provider Demographics
NPI:1407141393
Name:ALVAREZ-RODRIGUEZ, DIANE (DMD, MS)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ALVAREZ-RODRIGUEZ
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:18911 COLLINS AVE
Mailing Address - Street 2:#1507
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2387
Mailing Address - Country:US
Mailing Address - Phone:305-934-1034
Mailing Address - Fax:
Practice Address - Street 1:18911 COLLINS AVE
Practice Address - Street 2:#1507
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-2387
Practice Address - Country:US
Practice Address - Phone:305-934-1034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN182531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics