Provider Demographics
NPI:1720348055
Name:ALVAREZ, JASON ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ROBERT
Last Name:ALVAREZ
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 1:2881 HIGHWAY 190 STE D4
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3248
Mailing Address - Country:US
Mailing Address - Phone:985-626-8980
Mailing Address - Fax:985-727-4660
Practice Address - Street 1:2881 HIGHWAY 190 STE D4
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3248
Practice Address - Country:US
Practice Address - Phone:985-626-8980
Practice Address - Fax:985-727-4660
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA62611223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2852582Medicaid