Provider Demographics
NPI:1245086768
Name:MARIO ALEMAN DDS DENTAL CORP
Entity type:Organization
Organization Name:MARIO ALEMAN DDS DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-305-2324
Mailing Address - Street 1:1111 W COVINA BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3205
Mailing Address - Country:US
Mailing Address - Phone:909-305-2324
Mailing Address - Fax:909-305-9750
Practice Address - Street 1:1111 W COVINA BLVD STE 240
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3205
Practice Address - Country:US
Practice Address - Phone:909-305-2324
Practice Address - Fax:909-305-9750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental