Provider Demographics
NPI:1922251727
Name:GALLIANI ALVAREZ, MIRTHA GIANNINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIRTHA
Middle Name:GIANNINA
Last Name:GALLIANI ALVAREZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:3000 WASHINGTON BLVD APT 713
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-2153
Mailing Address - Country:US
Mailing Address - Phone:410-456-4584
Mailing Address - Fax:301-368-3131
Practice Address - Street 1:3460 OLD WASHINGTON RD STE 200
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3242
Practice Address - Country:US
Practice Address - Phone:301-645-6556
Practice Address - Fax:301-638-3131
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD142241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry