Provider Demographics
NPI:1154421048
Name:ALBA ORTHODONTICS LLC
Entity type:Organization
Organization Name:ALBA ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ALBA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-697-6393
Mailing Address - Street 1:116 CUMBERLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5667
Mailing Address - Country:US
Mailing Address - Phone:717-697-6393
Mailing Address - Fax:
Practice Address - Street 1:116 CUMBERLAND PKWY
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-5667
Practice Address - Country:US
Practice Address - Phone:717-697-6393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023048L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty