Provider Demographics
NPI:1558479337
Name:ALFANO, SAMUEL PERRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:PERRY
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 1:4496 CALLAGHAN RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-3400
Mailing Address - Country:US
Mailing Address - Phone:210-435-4601
Mailing Address - Fax:210-435-7131
Practice Address - Street 1:4496 CALLAGHAN RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-3400
Practice Address - Country:US
Practice Address - Phone:210-435-4601
Practice Address - Fax:210-435-7131
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00704262OtherUNITED CONCORDIA
TXB09277-01OtherTEXAS CHIP PROVIDER ID
TX00M240OtherBC/BS PROVIDER ID