Provider Demographics
NPI:1346537024
Name:ALONSO, LETICIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:
Last Name:ALONSO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 SW 8TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2949
Mailing Address - Country:US
Mailing Address - Phone:305-442-0020
Mailing Address - Fax:305-442-0050
Practice Address - Street 1:3934 SW 8TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2949
Practice Address - Country:US
Practice Address - Phone:305-442-0020
Practice Address - Fax:305-442-0050
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN194071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice