Provider Demographics
NPI:1578907747
Name:ALEGRIA, CONRADO V (DDS)
Entity Type:Individual
Prefix:
First Name:CONRADO
Middle Name:V
Last Name:ALEGRIA
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 1:505 HARMON LOOP ROAD, SUITE 300
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GUAM
Mailing Address - Zip Code:96929
Mailing Address - Country:UM
Mailing Address - Phone:671-637-9696
Mailing Address - Fax:671-637-6464
Practice Address - Street 1:505 HARMON LOOP ROAD, SUITE 300
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GUAM
Practice Address - Zip Code:96929
Practice Address - Country:UM
Practice Address - Phone:671-637-9696
Practice Address - Fax:671-637-6464
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39746122300000X
GUD9021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA39746Medicaid
GUD902Medicaid