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General NPI Number Information
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NPI Number | 1265650873
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Entity Type | Organization
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Legal Business Name | MARINO ALEA IGLESIAS, DDS CLINICA DENTAL
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Dates
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Enumeration Date | 04/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5209 W 65TH ST
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City | LITTLE ROCK
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State | AR
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Zip | 72209-3817
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Country | US
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Telephone | 501-565-7881
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Fax |
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Provider Business Mailing Address
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Address Line | 32 MONTVALE DR
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City | LITTLE ROCK
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State | AR
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Zip | 72212-2633
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Country | US
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Telephone | 501-217-9185
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MARINO ALEA IGLESIAS
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Credential | DDS
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Telephone | 501-217-9185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3501
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License Number State | AR
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