Provider Demographics
NPI:1437611209
Name:ALVAREZ, JENNY ALEJANDRA (DDS)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:ALEJANDRA
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E MERRITT ISLAND CSWY STE 105
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3514
Mailing Address - Country:US
Mailing Address - Phone:321-453-8882
Mailing Address - Fax:
Practice Address - Street 1:800 E MERRITT ISLAND CSWY STE 105
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3514
Practice Address - Country:US
Practice Address - Phone:321-453-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401418829122300000X
FLDH26534124Q00000X
FLDRPM2531390200000X
FL29648122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No124Q00000XDental ProvidersDental Hygienist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program