Provider Demographics
NPI:1093913618
Name:ALFONSO, CHRISTINA RANAE (RDH)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:RANAE
Last Name:ALFONSO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 SINSABAUGH RD
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-5428
Mailing Address - Country:US
Mailing Address - Phone:845-744-5685
Mailing Address - Fax:
Practice Address - Street 1:751 BRIGGS HWY
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-5501
Practice Address - Country:US
Practice Address - Phone:845-647-4509
Practice Address - Fax:845-647-2302
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021248124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist