Provider Demographics
NPI:1265626915
Name:ALFONSO-PAGAN, ANTONIA H (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTONIA
Middle Name:H
Last Name:ALFONSO-PAGAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 195152
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5152
Mailing Address - Country:US
Mailing Address - Phone:787-457-5999
Mailing Address - Fax:
Practice Address - Street 1:B-15 STREET 2
Practice Address - Street 2:PARKSIDE
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-793-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28071223G0001X
NY0541521223G0001X
PADS0378251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice