Provider Demographics
NPI:1366783060
Name:SERRANO, ALBERT P (DDS)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:P
Last Name:SERRANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E MISSOURI AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2446
Mailing Address - Country:US
Mailing Address - Phone:602-274-7840
Mailing Address - Fax:602-274-7956
Practice Address - Street 1:1515 E MISSOURI AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2446
Practice Address - Country:US
Practice Address - Phone:602-274-7840
Practice Address - Fax:602-274-7956
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics