Provider Demographics
NPI:1396095394
Name:ALVARADO FAMILY DENTISTRY
Entity type:Organization
Organization Name:ALVARADO FAMILY DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ESEOGHENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:OKUGBAYE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-698-1440
Mailing Address - Street 1:905 N CUMMINGS DR
Mailing Address - Street 2:
Mailing Address - City:ALVARADO
Mailing Address - State:TX
Mailing Address - Zip Code:76009-3258
Mailing Address - Country:US
Mailing Address - Phone:817-783-6700
Mailing Address - Fax:
Practice Address - Street 1:905 N. CUMMINGS DRIVE
Practice Address - Street 2:
Practice Address - City:ALAVARDO
Practice Address - State:TX
Practice Address - Zip Code:76009
Practice Address - Country:US
Practice Address - Phone:817-783-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26223261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental