Provider Demographics
NPI:1669025755
Name:ALFARO, ALBERTO (DMD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:ALFARO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633D MEDICAL GROUP
Mailing Address - Street 2:76 NEALY AVE BUILDING #92
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:23665
Mailing Address - Country:US
Mailing Address - Phone:757-225-7630
Mailing Address - Fax:
Practice Address - Street 1:633D MEDICAL GROUP
Practice Address - Street 2:76 NEALY AVE BUILDING #92
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:23665
Practice Address - Country:US
Practice Address - Phone:757-225-7630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027618001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice