Provider Demographics
NPI:1205252301
Name:ALPHA DENTAL GROUP, INC
Entity type:Organization
Organization Name:ALPHA DENTAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANEGER
Authorized Official - Prefix:
Authorized Official - First Name:YAREMI
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-238-7406
Mailing Address - Street 1:4999 W 8TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3409
Mailing Address - Country:US
Mailing Address - Phone:786-238-7406
Mailing Address - Fax:786-238-7429
Practice Address - Street 1:4999 W AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:786-238-7406
Practice Address - Fax:786-238-7429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty