MEDICARE: AREVALO MARCOS DENTAL CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	33895	CA

General Provider Information

NPI Number	:	1750508867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AREVALO MARCOS DENTAL CARE INC

Provider Business Mailing Address
First Line	:	3998 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-1050
Country	:	US
Telephone Number	:	415-239-8511
Fax Number	:	415-239-1366

Provider Business Practice Location Address
First Line	:	3998 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-1050
Country	:	US
Telephone Number	:	415-239-8511
Fax Number	:	415-239-1366

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALICIA AREVALO MARCOS
Credential	:	DMD
Telephone Number	:	415-239-8511

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/22/2020

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