Daniel, Roosevelt Alfonso

Daniel, Roosevelt Alfonso is an sole proprietor health care provider with primary practice located at 524 E Edgemont Ave , Montgomery AL 36111-1321. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Daniel, Roosevelt Alfonso can be contacted via phone (334) 834-9647.

Contact Information

Primary practice address
524 E Edgemont Ave Montgomery AL 36111-1321
Phone: (334) 834-9647
Fax: (334) 834-3716
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 3328 Alabama

Profile Details

NPI number 1043344617
LBN Legal business name Daniel, Roosevelt Alfonso
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 15th, 2007
Last updated Jul 8th, 2007 - about 18 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 1043344617 NPPES
Alabama Other 51091556 BCBSAL
Alabama MEDICAID 000091556 BCBSAL

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