Provider Demographics
NPI:1013058247
Name:ALONSO, MADELEN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MADELEN
Middle Name:
Last Name:ALONSO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MADELEN
Other - Middle Name:
Other - Last Name:ALONSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:7835 SW 158TH TER
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2330
Mailing Address - Country:US
Mailing Address - Phone:786-388-1554
Mailing Address - Fax:
Practice Address - Street 1:7835 SW 158TH TER
Practice Address - Street 2:
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-2330
Practice Address - Country:US
Practice Address - Phone:786-388-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16653122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist