Provider Demographics
NPI:1740585256
Name:ALVIN DENTAL CARE
Entity Type:Organization
Organization Name:ALVIN DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:B
Authorized Official - Last Name:FOURNIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-331-0020
Mailing Address - Street 1:1701 FAIRWAY DR STE 20
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-4678
Mailing Address - Country:US
Mailing Address - Phone:281-331-0020
Mailing Address - Fax:281-585-0505
Practice Address - Street 1:1701 FAIRWAY DR STE 20
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-4678
Practice Address - Country:US
Practice Address - Phone:281-331-0020
Practice Address - Fax:281-585-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX127791223G0001X
TX154001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty