Provider Demographics
NPI:1649921321
Name:SILVA ALVAREZ, MARIELLE (RDH)
Entity type:Individual
Prefix:
First Name:MARIELLE
Middle Name:
Last Name:SILVA ALVAREZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23673 W MOHAVE ST
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-3525
Mailing Address - Country:US
Mailing Address - Phone:520-705-1055
Mailing Address - Fax:
Practice Address - Street 1:338 N 15TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-2402
Practice Address - Country:US
Practice Address - Phone:602-688-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH008081124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist