Provider Demographics
NPI:1831150150
Name:ALFONSO, EMMANUEL LINGAD (DDS)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:LINGAD
Last Name:ALFONSO
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 1:15940 AMAR RD
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91744-2201
Mailing Address - Country:US
Mailing Address - Phone:626-336-3404
Mailing Address - Fax:626-330-3542
Practice Address - Street 1:15940 AMAR RD
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91744-2201
Practice Address - Country:US
Practice Address - Phone:626-336-3404
Practice Address - Fax:626-330-3542
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA382461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice