Provider Demographics
NPI:1407224637
Name:ALTONAGA, ANA (DMD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:ALTONAGA
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 1:16039 S 9TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-1941
Mailing Address - Country:US
Mailing Address - Phone:480-460-2474
Mailing Address - Fax:
Practice Address - Street 1:15215 S 48TH ST STE 158
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-9139
Practice Address - Country:US
Practice Address - Phone:480-598-3006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD4496122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ200346842OtherTAX ID