Provider Demographics
NPI:1245247766
Name:ALFANO, DAVID C (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
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:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:NY
Mailing Address - Zip Code:13697-0104
Mailing Address - Country:US
Mailing Address - Phone:315-389-4865
Mailing Address - Fax:315-389-4865
Practice Address - Street 1:652 STATE HIGHWAY 11C
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:NY
Practice Address - Zip Code:13697-3244
Practice Address - Country:US
Practice Address - Phone:315-389-4865
Practice Address - Fax:315-389-4865
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0328511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice