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General NPI Number Information
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NPI Number | 1740585256
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Entity Type | Organization
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Legal Business Name | ALVIN DENTAL CARE
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Dates
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Enumeration Date | 01/13/2011
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Last Update Date | 01/13/2011
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Provider Practice Location Address
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Address Line | 1701 FAIRWAY DR STE 20
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City | ALVIN
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State | TX
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Zip | 77511-4678
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Country | US
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Telephone | 281-331-0020
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Fax | 281-585-0505
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Provider Business Mailing Address
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Address Line | 1701 FAIRWAY DR STE 20
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City | ALVIN
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State | TX
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Zip | 77511-4678
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Country | US
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Telephone | 281-331-0020
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Fax | 281-585-0505
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAYMOND B FOURNIER
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Credential | DDS
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Telephone | 281-331-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 15400
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12779
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License Number State | TX
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