Provider Demographics
NPI:1356618805
Name:ALVEAR DENTAL OFFICE P.C.
Entity type:Organization
Organization Name:ALVEAR DENTAL OFFICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVEAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-639-8932
Mailing Address - Street 1:5117 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4540
Mailing Address - Country:US
Mailing Address - Phone:718-639-8932
Mailing Address - Fax:718-301-0195
Practice Address - Street 1:5117 43RD AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4540
Practice Address - Country:US
Practice Address - Phone:718-639-8932
Practice Address - Fax:718-301-0195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044882-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01468560Medicaid