Provider Demographics
NPI:1538493275
Name:ALVAREZ, JUAN EDUARDO (DDS)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:EDUARDO
Last Name:ALVAREZ
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 1:21287 SOUTHOLME WAY
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6087
Mailing Address - Country:US
Mailing Address - Phone:585-694-2102
Mailing Address - Fax:
Practice Address - Street 1:21287 SOUTHOLME WAY
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6087
Practice Address - Country:US
Practice Address - Phone:585-694-2102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2015-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA04014129581223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program