Provider Demographics
NPI:1679066690
Name:RICHARD BENJAMIN ALVAREZ DDS, LLC
Entity type:Organization
Organization Name:RICHARD BENJAMIN ALVAREZ DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-737-3345
Mailing Address - Street 1:345 SHORES PKWY
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-7704
Mailing Address - Country:US
Mailing Address - Phone:417-737-3345
Mailing Address - Fax:
Practice Address - Street 1:14303 STATE HIGHWAY 38
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-8952
Practice Address - Country:US
Practice Address - Phone:417-859-0711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014018213261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental