Provider Demographics
NPI:1801001490
Name:ALPHA DENTAL CORPORATION
Entity Type:Organization
Organization Name:ALPHA DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:I
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-943-3700
Mailing Address - Street 1:9201 N 29TH AVE STE 33
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-3470
Mailing Address - Country:US
Mailing Address - Phone:602-943-3700
Mailing Address - Fax:602-943-3701
Practice Address - Street 1:9201 N 29TH AVE STE 33
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-3470
Practice Address - Country:US
Practice Address - Phone:602-943-3700
Practice Address - Fax:602-943-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty