Healthcare Provider Details

I. General information

NPI: 1780689760
Provider Name (Legal Business Name): BYRON D. ALDER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/25/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

175 S. EL MOLINO AVE STE 2
PASADENA CA
91101-2564
US

IV. Provider business mailing address

175 S EL MOLINO AVE STE 2
PASADENA CA
91101-2564
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-3903
  • Fax:
Mailing address:
  • Phone: 626-792-3903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: