Provider Demographics
NPI:1619206752
Name:NOGUERA, ALBERTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:
Last Name:NOGUERA
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 1:12150 LAKE UNDERHILL RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-5012
Mailing Address - Country:US
Mailing Address - Phone:321-319-7027
Mailing Address - Fax:
Practice Address - Street 1:12150 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5012
Practice Address - Country:US
Practice Address - Phone:321-319-7027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN237831223P0221X
FLDTP5261223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108537600Medicaid
FL002096100Medicaid