Provider Demographics
NPI:1396330551
Name:ALVA, JUAN (RDH)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:ALVA
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6527 68TH ST E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-9760
Mailing Address - Country:US
Mailing Address - Phone:941-524-1878
Mailing Address - Fax:
Practice Address - Street 1:814 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-1706
Practice Address - Country:US
Practice Address - Phone:863-687-8475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21058124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist