Provider Demographics
NPI:1497029755
Name:LOREN D ALVES, DMD, PA
Entity Type:Organization
Organization Name:LOREN D ALVES, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALVES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:210-208-6525
Mailing Address - Street 1:1954 E HOUSTON ST
Mailing Address - Street 2:STE. 210
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78202-2951
Mailing Address - Country:US
Mailing Address - Phone:210-208-6525
Mailing Address - Fax:210-208-6528
Practice Address - Street 1:1954 E HOUSTON ST
Practice Address - Street 2:STE. 210
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78202-2951
Practice Address - Country:US
Practice Address - Phone:210-208-6525
Practice Address - Fax:210-208-6528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151152902Medicaid