Provider Demographics
NPI:1689256315
Name:ALVARENGA, LUIS (DDS)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:ALVARENGA
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 1:3150 PANAMA LN UNIT I
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313
Mailing Address - Country:US
Mailing Address - Phone:661-412-0831
Mailing Address - Fax:
Practice Address - Street 1:3150 PANAMA LN UNIT I
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313
Practice Address - Country:US
Practice Address - Phone:661-412-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108117122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist