Provider Demographics
NPI:1508319229
Name:STEPHEN G ALFANO DDS INC
Entity Type:Organization
Organization Name:STEPHEN G ALFANO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:ALFANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-673-7820
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALBOA ISLAND DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-28
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty