Provider Demographics
NPI:1285893792
Name:ALEJANDRO ECHEVERRY DDS & MAURICIO FONRODONA DDS INC.
Entity type:Organization
Organization Name:ALEJANDRO ECHEVERRY DDS & MAURICIO FONRODONA DDS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHEVERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-524-9100
Mailing Address - Street 1:1317 W VENTURA ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93015-1690
Mailing Address - Country:US
Mailing Address - Phone:805-524-9100
Mailing Address - Fax:805-524-9500
Practice Address - Street 1:1317 W VENTURA ST UNIT C
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015-1690
Practice Address - Country:US
Practice Address - Phone:805-524-9100
Practice Address - Fax:805-524-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA498761223G0001X
261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG89695-01OtherDENTICAL