Healthcare Provider Details

I. General information

NPI: 1093414609
Provider Name (Legal Business Name): R. MICHAEL ALVAREZ, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2188 PERALTA BLVD STE D
FREMONT CA
94536-3941
US

IV. Provider business mailing address

2188 PERALTA BLVD STE D
FREMONT CA
94536-3941
US

V. Phone/Fax

Practice location:
  • Phone: 510-713-6790
  • Fax: 510-713-6794
Mailing address:
  • Phone: 510-713-6790
  • Fax: 510-713-6794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LOLA NIETO
Title or Position: OFFICE MANAGER
Credential:
Phone: 510-713-6790