Provider Demographics
NPI:1386914125
Name:MARINO J. ALEA IGLESIAS, DDS, P.C
Entity type:Organization
Organization Name:MARINO J. ALEA IGLESIAS, DDS, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARINO
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALEA IGLESIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-833-7392
Mailing Address - Street 1:2425 NAGLEE RD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304-7324
Mailing Address - Country:US
Mailing Address - Phone:209-833-7392
Mailing Address - Fax:
Practice Address - Street 1:2425 NAGLEE RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304-7324
Practice Address - Country:US
Practice Address - Phone:209-833-7392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty