Provider Demographics
NPI:1003978107
Name:ALFARO DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:ALFARO DENTAL CARE, P.C.
Other - Org Name:WALESKA ALFARO DMD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALESKA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALFARO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-842-9912
Mailing Address - Street 1:2350 BELMONT CIR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-1568
Mailing Address - Country:US
Mailing Address - Phone:678-842-9912
Mailing Address - Fax:678-842-9913
Practice Address - Street 1:2350 BELMONT CIR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-1568
Practice Address - Country:US
Practice Address - Phone:678-842-9912
Practice Address - Fax:678-842-9913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0121551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA107870OtherDORAL LOCATION #