Basic Information
Provider Information
NPI: 1871982553
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUGARTE
FirstName: ALBA
MiddleName: NATALIA
NamePrefix:  
NameSuffix:  
Credential: DDS,MS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2422 DEVONSHIRE DR
Address2:  
City: PEARLAND
State: TX
PostalCode: 775841554
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1205 LAKE RD
Address2:  
City: LA MARQUE
State: TX
PostalCode: 775685205
CountryCode: US
TelephoneNumber: 4099388018
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/18/2015
LastUpdateDate: 01/18/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223P0700X30382TXY Dental ProvidersDentistProsthodontics

No ID Information.


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