Provider Demographics
NPI:1841870227
Name:DESCALZO-ALFONSO, YASMIL (DDS)
Entity type:Individual
Prefix:
First Name:YASMIL
Middle Name:
Last Name:DESCALZO-ALFONSO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 MAIN ST APT 1616
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2296
Mailing Address - Country:US
Mailing Address - Phone:786-281-5787
Mailing Address - Fax:
Practice Address - Street 1:7735 NW 146TH ST STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1583
Practice Address - Country:US
Practice Address - Phone:305-556-0528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-10
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11838122300000X
FLDN28776122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist