Provider Demographics
NPI:1336023191
Name:ALVAREZ, ALYSSA RENEE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:RENEE
Last Name:ALVAREZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 N FEDERAL HWY APT 621
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1092
Mailing Address - Country:US
Mailing Address - Phone:786-537-5596
Mailing Address - Fax:
Practice Address - Street 1:2701 W OAKLAND PARK BLVD STE 205B
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1330
Practice Address - Country:US
Practice Address - Phone:954-296-3632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN30474122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist