Provider Demographics
NPI:1831491745
Name:ALFONSO DENTAL OFFICE. P.C.
Entity Type:Organization
Organization Name:ALFONSO DENTAL OFFICE. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-796-2727
Mailing Address - Street 1:100-102 POST AVENUE 204TH ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-3406
Mailing Address - Country:US
Mailing Address - Phone:646-796-2727
Mailing Address - Fax:646-796-2777
Practice Address - Street 1:100-102 POST AVENUE 204TH ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-3406
Practice Address - Country:US
Practice Address - Phone:646-796-2727
Practice Address - Fax:646-796-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental