Provider Demographics
NPI:1952704280
Name:ELIZABETH ALFUENTE, DMD, PLLC
Entity Type:Organization
Organization Name:ELIZABETH ALFUENTE, DMD, PLLC
Other - Org Name:ATLANTIC FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-221-3550
Mailing Address - Street 1:12777 ATLANTIC BLVD
Mailing Address - Street 2:STE #26
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-7120
Mailing Address - Country:US
Mailing Address - Phone:904-221-3550
Mailing Address - Fax:904-221-3227
Practice Address - Street 1:12777 ATLANTIC BLVD
Practice Address - Street 2:STE #26
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7120
Practice Address - Country:US
Practice Address - Phone:904-221-3550
Practice Address - Fax:904-221-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN186281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty