Provider Demographics
NPI:1760992523
Name:MARILOU C. ALQUIROS, DMD, INC.
Entity Type:Organization
Organization Name:MARILOU C. ALQUIROS, DMD, INC.
Other - Org Name:ALQUIROS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILOU
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALQUIROS-COLLOSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-852-0884
Mailing Address - Street 1:125 W ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6208
Mailing Address - Country:US
Mailing Address - Phone:626-852-0884
Mailing Address - Fax:626-852-0885
Practice Address - Street 1:125 W ROUTE 66
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6208
Practice Address - Country:US
Practice Address - Phone:626-852-0884
Practice Address - Fax:626-852-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41578261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid