Provider Demographics
NPI:1215120225
Name:ALANIZ, ROBERTO R (DDS)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:R
Last Name:ALANIZ
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 1:25025 RED MAPLE LN STE 105
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-1137
Mailing Address - Country:US
Mailing Address - Phone:951-924-6370
Mailing Address - Fax:951-924-6374
Practice Address - Street 1:25025 RED MAPLE LN STE 105
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-1137
Practice Address - Country:US
Practice Address - Phone:951-924-6370
Practice Address - Fax:951-924-6374
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47031122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215120225OtherMEDICAL