Provider Demographics
NPI:1518004944
Name:ALEA IGLESIAS, MARINO JAVIER (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARINO
Middle Name:JAVIER
Last Name:ALEA IGLESIAS
Suffix:
Gender:M
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:PO BOX 1293
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-1293
Mailing Address - Country:US
Mailing Address - Phone:501-256-1030
Mailing Address - Fax:
Practice Address - Street 1:5209 W 65TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-3817
Practice Address - Country:US
Practice Address - Phone:501-565-7881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35051223G0001X
CA60649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice