Provider Demographics
NPI:1639443575
Name:OTTO R. ALONZO, D.D.S., INC.
Entity Type:Organization
Organization Name:OTTO R. ALONZO, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:ALONZO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-776-1829
Mailing Address - Street 1:145 SHAW AVE
Mailing Address - Street 2:SUITE B2
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-3841
Mailing Address - Country:US
Mailing Address - Phone:559-325-2175
Mailing Address - Fax:559-325-2227
Practice Address - Street 1:145 SHAW AVE
Practice Address - Street 2:SUITE B2
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3841
Practice Address - Country:US
Practice Address - Phone:559-325-2175
Practice Address - Fax:559-325-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50719261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental