Provider Demographics
NPI:1992936645
Name:RICHARD A. ALVERSON, D.D.S., P.C.
Entity type:Organization
Organization Name:RICHARD A. ALVERSON, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ALVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-998-8816
Mailing Address - Street 1:10615 N HAYDEN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5577
Mailing Address - Country:US
Mailing Address - Phone:480-998-8816
Mailing Address - Fax:480-596-3445
Practice Address - Street 1:10615 N HAYDEN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5577
Practice Address - Country:US
Practice Address - Phone:480-998-8816
Practice Address - Fax:480-596-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ22641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty