Provider Demographics
NPI:1902978851
Name:ALANIS, MARKO EVERARDO (DDS)
Entity type:Individual
Prefix:DR
First Name:MARKO
Middle Name:EVERARDO
Last Name:ALANIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 W FREDDY GONZALEZ DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539
Mailing Address - Country:US
Mailing Address - Phone:956-383-8880
Mailing Address - Fax:956-383-6889
Practice Address - Street 1:3525 W FREDDY GONZALEZ DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-383-8880
Practice Address - Fax:956-383-6889
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20517122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB205171OtherCHIP
TXG60172OtherDELTA CHIP PROGRAM