Provider Demographics
NPI:1891083739
Name:POPE, STEPHAN ALONSO (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:ALONSO
Last Name:POPE
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 1:2439 MONARCH DR
Mailing Address - Street 2:SUITE #4
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6840
Mailing Address - Country:US
Mailing Address - Phone:956-723-1230
Mailing Address - Fax:
Practice Address - Street 1:2439 MONARCH DR
Practice Address - Street 2:SUITE #4
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6840
Practice Address - Country:US
Practice Address - Phone:956-723-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice