MEDICARE: STEPHEN G ALFANO DDS INC

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	122300000X	Dentist	56564	CA

General Provider Information

NPI Number	:	1508319229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN G ALFANO DDS INC

Provider Business Mailing Address
First Line	:	217 MARINE AVE STE A
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92662-1289
Country	:	US
Telephone Number	:	949-673-7820
Fax Number	:	949-673-6682

Provider Business Practice Location Address
First Line	:	217 MARINE AVE STE A
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92662-1289
Country	:	US
Telephone Number	:	949-673-7820
Fax Number	:	949-673-6682

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	STEPHEN G ALFANO
Credential	:	DDS
Telephone Number	:	949-673-7820

Provider Enumeration Date	:	07/28/2016
Last Update Date	:	12/06/2016

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