Provider Demographics
NPI:1467926428
Name:ALTA DENTAL PLLC
Entity Type:Organization
Organization Name:ALTA DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-642-0948
Mailing Address - Street 1:6104 S 1ST ST STE 103
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4052
Mailing Address - Country:US
Mailing Address - Phone:951-642-0948
Mailing Address - Fax:
Practice Address - Street 1:6104 S 1ST ST STE 103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4052
Practice Address - Country:US
Practice Address - Phone:951-642-0648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-13
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty