Provider Demographics
NPI:1730300609
Name:RO, ALVIN S (DDS)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:S
Last Name:RO
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 1:19341 CYPRESS HILL WAY
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-4983
Mailing Address - Country:US
Mailing Address - Phone:301-869-8894
Mailing Address - Fax:
Practice Address - Street 1:198 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 11
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4398
Practice Address - Country:US
Practice Address - Phone:301-682-8181
Practice Address - Fax:301-682-8183
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD126021223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics