Provider Demographics
NPI:1508912676
Name:ALVARO, ALISA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:
Last Name:ALVARO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-2837
Mailing Address - Country:US
Mailing Address - Phone:415-924-7641
Mailing Address - Fax:415-970-2237
Practice Address - Street 1:345 ESTUDILLO AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4702
Practice Address - Country:US
Practice Address - Phone:510-895-1776
Practice Address - Fax:510-895-4440
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA395061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice