Provider Demographics
NPI:1982871323
Name:ARRIBAS, ALFREDO ROBERTO (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:ROBERTO
Last Name:ARRIBAS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10175 GATEWAY BLVD W
Mailing Address - Street 2:SUITE 304
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7618
Mailing Address - Country:US
Mailing Address - Phone:504-957-7866
Mailing Address - Fax:
Practice Address - Street 1:10175 GATEWAY BLVD W
Practice Address - Street 2:SUITE 304
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7618
Practice Address - Country:US
Practice Address - Phone:504-957-7866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX285021223S0112X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX310231101Medicaid
LA4C480Medicare PIN
LAU92653Medicare UPIN