Provider Demographics
NPI:1619466638
Name:ALPHA DENTAL CENTER, P.C
Entity Type:Organization
Organization Name:ALPHA DENTAL CENTER, P.C
Other - Org Name:FALL RIVER DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIS
Authorized Official - Prefix:MR
Authorized Official - First Name:MUNAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-567-4379
Mailing Address - Street 1:516 NEWTON ST.
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721
Mailing Address - Country:US
Mailing Address - Phone:508-567-4379
Mailing Address - Fax:508-617-8267
Practice Address - Street 1:516 NEWTON ST.
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721
Practice Address - Country:US
Practice Address - Phone:508-567-4379
Practice Address - Fax:508-617-8267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty