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General NPI Number Information
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NPI Number | 1275302283
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Entity Type | Organization
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Legal Business Name | RICARDO S. DE ALA DMD INC.
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 37120 FREMONT BLVD STE G
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City | FREMONT
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State | CA
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Zip | 94536-3816
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Country | US
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Telephone | 510-396-5459
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Fax | 510-657-8936
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Provider Business Mailing Address
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Address Line | 37120 FREMONT BLVD STE G
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City | FREMONT
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State | CA
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Zip | 94536-3816
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Country | US
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Telephone | 510-657-8907
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Fax | 510-657-8936
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICARDO S DE ALA
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Credential | DMD
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Telephone | 510-396-5459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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