Provider Demographics
NPI:1427045236
Name:ALFANO, STEPHEN GLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GLEN
Last Name:ALFANO
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 1:217 MARINE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92662-1289
Mailing Address - Country:US
Mailing Address - Phone:949-673-7820
Mailing Address - Fax:949-673-6682
Practice Address - Street 1:217 MARINE AVE STE A
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92662-1289
Practice Address - Country:US
Practice Address - Phone:949-673-7820
Practice Address - Fax:949-673-6682
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039820122300000X
TX170581223P0700X
CA56564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics