Healthcare Provider Details

I. General information

NPI: 1114546686
Provider Name (Legal Business Name): DESIREE NICOLE MUNOZ ALVARADO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143-6 CALLE 401
CAROLINA PR
00985-4022
US

IV. Provider business mailing address

143-6 CALLE 401
CAROLINA PR
00985-4022
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-0485
  • Fax:
Mailing address:
  • Phone: 787-768-0485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number3358
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: