Provider Demographics
NPI:1700082807
Name:ALARCON-VARGAS DENTAL CORPORATION
Entity Type:Organization
Organization Name:ALARCON-VARGAS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:OLIVIA
Authorized Official - Last Name:ALARCON-VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-560-7474
Mailing Address - Street 1:4566 E. FLORENCE AVE
Mailing Address - Street 2:STE 8
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-4347
Mailing Address - Country:US
Mailing Address - Phone:323-560-7474
Mailing Address - Fax:323-560-0424
Practice Address - Street 1:4566 E. FLORENCE AVE
Practice Address - Street 2:STE 8
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-4347
Practice Address - Country:US
Practice Address - Phone:323-560-7474
Practice Address - Fax:323-560-0424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty