Alfonso, Antonio Andrew

Alfonso, Antonio Andrew is an sole proprietor health care provider with primary practice located at 732 Mott St # 100-110 , San Fernando CA 91340-4237. He recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Dentist. Dental Providers / Dentist is his primary health care specialty. Alfonso, Antonio Andrew can be contacted via phone (818) 963-5690.

Contact Information

Primary practice address
732 Mott St # 100-110 San Fernando CA 91340-4237
Phone: (818) 963-5690
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 63500 California
Dental Providers / Dentist 122300000X 63500 California

Profile Details

NPI number 1346655677
LBN Legal business name Alfonso, Antonio Andrew
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 25th, 2014
Last updated Apr 21st, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346655677 NPPES
California MEDICAID 63500

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