Provider Demographics
NPI:1861850091
Name:ALVAREZ & BERNARDO DENTAL CORPORATIO
Entity Type:Organization
Organization Name:ALVAREZ & BERNARDO DENTAL CORPORATIO
Other - Org Name:BERNARDO & ALVAREZ DENTAL GROUP, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERAFIN
Authorized Official - Middle Name:LABAO
Authorized Official - Last Name:BERNARDO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-242-6088
Mailing Address - Street 1:24655 SUNNYMEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3760
Mailing Address - Country:US
Mailing Address - Phone:951-242-6088
Mailing Address - Fax:951-242-5050
Practice Address - Street 1:24655 SUNNYMEAD BLVD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3760
Practice Address - Country:US
Practice Address - Phone:951-242-6088
Practice Address - Fax:951-242-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1134261480Medicaid