Provider Demographics
NPI:1982710331
Name:ALAS, ANDERSON GUSTAVO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDERSON
Middle Name:GUSTAVO
Last Name:ALAS
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 1:1413 FOOTHILL BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750
Mailing Address - Country:US
Mailing Address - Phone:909-593-7561
Mailing Address - Fax:909-447-7004
Practice Address - Street 1:1413 FOOTHILL BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750
Practice Address - Country:US
Practice Address - Phone:909-593-7561
Practice Address - Fax:909-447-7004
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37775122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9285101OtherDENTI CAL