Provider Demographics
NPI:1417609447
Name:ALVA DENTAL STUDIO PLLC
Entity Type:Organization
Organization Name:ALVA DENTAL STUDIO PLLC
Other - Org Name:TULSA SCULPTED SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:BRASHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-474-6362
Mailing Address - Street 1:4415 S HARVARD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2616
Mailing Address - Country:US
Mailing Address - Phone:918-742-2096
Mailing Address - Fax:
Practice Address - Street 1:4415 S HARVARD AVE STE 102
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2616
Practice Address - Country:US
Practice Address - Phone:918-742-2096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty