Provider Demographics
NPI:1316483704
Name:ALLIGATOR DENTAL CIBOLO, PLLC
Entity type:Organization
Organization Name:ALLIGATOR DENTAL CIBOLO, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-491-4105
Mailing Address - Street 1:808 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-2841
Mailing Address - Country:US
Mailing Address - Phone:830-491-4105
Mailing Address - Fax:
Practice Address - Street 1:1678 US HIGHWAY 181 N
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-2844
Practice Address - Country:US
Practice Address - Phone:830-491-4105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIGATOR DENTAL CIBOLO, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX241861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty