Healthcare Provider Details

I. General information

NPI: 1639464662
Provider Name (Legal Business Name): VICTOR MANUEL ALARCON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 02/13/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SACK BLVD
LEOMINSTER MA
01453-3325
US

IV. Provider business mailing address

356 PALISADE AVE APT 4F
JERSEY CITY NJ
07307-1778
US

V. Phone/Fax

Practice location:
  • Phone: 978-466-6800
  • Fax:
Mailing address:
  • Phone: 617-851-6805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1855732
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1855732
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: