Provider Demographics
NPI:1053726786
Name:LOPEZ- ALVAREZ, KIANI CAROLINA
Entity type:Individual
Prefix:
First Name:KIANI
Middle Name:CAROLINA
Last Name:LOPEZ- ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2907
Mailing Address - Country:US
Mailing Address - Phone:787-538-2624
Mailing Address - Fax:
Practice Address - Street 1:169 PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-2907
Practice Address - Country:US
Practice Address - Phone:914-965-3864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058365122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist