Provider Demographics
NPI:1134233174
Name:VODA, ALAN M (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:M
Last Name:VODA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ALAN
Other - Middle Name:M
Other - Last Name:VODA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6800 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE K
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1405
Mailing Address - Country:US
Mailing Address - Phone:505-881-8463
Mailing Address - Fax:505-883-7212
Practice Address - Street 1:6800 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE K
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1405
Practice Address - Country:US
Practice Address - Phone:505-881-8463
Practice Address - Fax:505-883-7212
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist