Provider Demographics
NPI:1134334626
Name:BROAS, ALBERTO O (DDS)
Entity type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:O
Last Name:BROAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 BROADWAY # S-204
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2976
Mailing Address - Country:US
Mailing Address - Phone:619-420-9027
Mailing Address - Fax:619-420-9037
Practice Address - Street 1:1295 BROADWAY # S-204
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2976
Practice Address - Country:US
Practice Address - Phone:619-420-9027
Practice Address - Fax:619-420-9037
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist