Provider Demographics
NPI:1912058439
Name:ALVAREZ, MARTHA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:A
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 FALL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2573
Mailing Address - Country:US
Mailing Address - Phone:214-394-5045
Mailing Address - Fax:
Practice Address - Street 1:312 FALL CREEK DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2573
Practice Address - Country:US
Practice Address - Phone:214-394-5045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF-216751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21675OtherCDC CHIP
TX165272902Medicaid
TX165272901Medicaid