Provider Demographics
NPI:1689045908
Name:ALVAREZ DENTAL SMILE
Entity Type:Organization
Organization Name:ALVAREZ DENTAL SMILE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTIC
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-433-0080
Mailing Address - Street 1:14 PIDGEON HILL DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6155
Mailing Address - Country:US
Mailing Address - Phone:703-433-0080
Mailing Address - Fax:703-433-0081
Practice Address - Street 1:14 PIDGEON HILL DR
Practice Address - Street 2:SUITE 170
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6155
Practice Address - Country:US
Practice Address - Phone:703-433-0080
Practice Address - Fax:703-433-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty