Provider Demographics
NPI:1164454831
Name:ALFANO, DAVID PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:ALFANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14037 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2401
Mailing Address - Country:US
Mailing Address - Phone:813-968-5743
Mailing Address - Fax:813-264-4231
Practice Address - Street 1:14037 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2401
Practice Address - Country:US
Practice Address - Phone:813-968-5743
Practice Address - Fax:813-264-4231
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00098121223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL077640800Medicaid