Provider Demographics
NPI:1295824753
Name:ALFONSO, ALBERT ANGELO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:ANGELO
Last Name:ALFONSO
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 1:714 BRIAR HILL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-1503
Mailing Address - Country:US
Mailing Address - Phone:281-948-3289
Mailing Address - Fax:
Practice Address - Street 1:10926 GRANT RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4445
Practice Address - Country:US
Practice Address - Phone:281-807-6555
Practice Address - Fax:281-469-5907
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice