Provider Demographics
NPI:1255491700
Name:ALCALDE, RAFAEL (DDS PA)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:ALCALDE
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 MASON CORBIN CT
Mailing Address - Street 2:SUITE #2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7733
Mailing Address - Country:US
Mailing Address - Phone:239-274-3794
Mailing Address - Fax:239-275-3513
Practice Address - Street 1:5150 MASON CORBIN CT
Practice Address - Street 2:SUITE #2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7733
Practice Address - Country:US
Practice Address - Phone:239-274-3794
Practice Address - Fax:239-275-3513
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 174101223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAV00312Medicare UPIN