Provider Demographics
NPI:1922600212
Name:EXPANSION DENTAL
Entity Type:Organization
Organization Name:EXPANSION DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IDALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-837-6052
Mailing Address - Street 1:3176 DANVILLE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-1905
Mailing Address - Country:US
Mailing Address - Phone:925-837-6052
Mailing Address - Fax:925-886-8497
Practice Address - Street 1:3176 DANVILLE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:CA
Practice Address - Zip Code:94507-1905
Practice Address - Country:US
Practice Address - Phone:925-837-6052
Practice Address - Fax:925-886-8497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental