Provider Demographics
NPI:1609078898
Name:ALPHA DENTAL CENTER, P.C.
Entity Type:Organization
Organization Name:ALPHA DENTAL CENTER, P.C.
Other - Org Name:ALPHA DENTAL CENTER, P.C. (FALL RIVER II)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVERSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-673-9132
Mailing Address - Street 1:385 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-1547
Mailing Address - Country:US
Mailing Address - Phone:508-673-9132
Mailing Address - Fax:507-673-7949
Practice Address - Street 1:385 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-1547
Practice Address - Country:US
Practice Address - Phone:508-673-9132
Practice Address - Fax:507-673-7949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
19828OtherDELTA DENTAL OF MA