Provider Demographics
NPI:1407901903
Name:PROENCA-AFONSO, INGRID F (DDS)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:F
Last Name:PROENCA-AFONSO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 WATERDOWN DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5312
Mailing Address - Country:US
Mailing Address - Phone:214-509-0722
Mailing Address - Fax:
Practice Address - Street 1:6031 SHERRY LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6402
Practice Address - Country:US
Practice Address - Phone:214-369-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23112122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist