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General NPI Number Information
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NPI Number | 1982710331
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Entity Type | Individual
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Provider Name | ANDERSON GUSTAVO ALAS DDS
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1413 FOOTHILL BLVD SUITE G
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City | LA VERNE
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State | CA
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Zip | 91750
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Country | US
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Telephone | 909-593-7561
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Fax | 909-447-7004
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Provider Business Mailing Address
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Address Line | 1413 FOOTHILL BLVD SUITE G
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City | LA VERNE
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State | CA
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Zip | 91750
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Country | US
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Telephone | 909-593-7561
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Fax | 909-447-7004
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 37775
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License Number State | CA
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