1821300773 NPI number — ALTERNATIVE OPPORTUNITIES

Table of content: DR. ROGER P. BOERO DDS, MSD (NPI 1528234747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821300773 NPI number — ALTERNATIVE OPPORTUNITIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTERNATIVE OPPORTUNITIES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821300773
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
602 N WALTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENTONVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72712-4576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-464-1060
Provider Business Mailing Address Fax Number:
479-271-6238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1817 WOODSPRINGS RD
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72401-0903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-934-9800
Provider Business Practice Location Address Fax Number:
870-934-8463
Provider Enumeration Date:
07/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BALDING
Authorized Official First Name:
HELEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CORP INSURANCE DIR
Authorized Official Telephone Number:
479-271-6107

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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