Provider Demographics
NPI:1831309491
Name:BLANCAFLOR, ALICE TANGI (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:TANGI
Last Name:BLANCAFLOR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:699 LEWELLING BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579
Mailing Address - Country:US
Mailing Address - Phone:510-333-8031
Mailing Address - Fax:510-523-5144
Practice Address - Street 1:699 LEWELLING BLVD
Practice Address - Street 2:STE 300
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94579
Practice Address - Country:US
Practice Address - Phone:510-333-8031
Practice Address - Fax:510-523-5144
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA384961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice