Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 058915 | NY |
N | 122300000X | Dentist | 22DI02550400 | NJ |
N | 122300000X | Dentist | DN20560 | FL |
Y | 1223P0300X | Periodontist | DN20560 | FL |
NPI | 1053712992 |
---|---|
Provider Name | Kenia E Alvarez |
First Address | Winter Park, FL 32789 |
Second Address | Winter Park, FL 32789-3656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2014 |
Last Update Date | 17/03/2018 |