MEDICARE: DR. GILDA F ALONZO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DN13259	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	DN13259	OTHER	FL	LICENSE NUMBER

General Provider Information

NPI Number	:	1134224041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GILDA F ALONZO D.D.S.

Provider Business Mailing Address
First Line	:	654 W INDIANTOWN RD STE 102
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-7546
Country	:	US
Telephone Number	:	561-747-3338
Fax Number	:	561-747-9133

Provider Business Practice Location Address
First Line	:	654 W INDIANTOWN RD STE 102
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-7546
Country	:	US
Telephone Number	:	561-747-3338
Fax Number	:	561-747-9133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	03/07/2023

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