Provider Demographics
NPI:1003823964
Name:ALONSO, ALEJANDRO
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:ALONSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10725 N LOOP DR STE 104
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:TX
Mailing Address - Zip Code:79927-4627
Mailing Address - Country:US
Mailing Address - Phone:347-520-0318
Mailing Address - Fax:
Practice Address - Street 1:10725 N LOOP DR STE 104
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:TX
Practice Address - Zip Code:79927-4627
Practice Address - Country:US
Practice Address - Phone:347-520-0318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344091223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice