MEDICARE: STEPHAN ALONSO POPE DDS

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	1223G0001X	General Practice Dentistry	27070	TX

General Provider Information

NPI Number	:	1891083739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHAN ALONSO POPE DDS

Provider Business Mailing Address
First Line	:	2439 MONARCH DR
Second Line	:	SUITE #4
City	:	LAREDO
State	:	TX
Zip	:	78045-6840
Country	:	US
Telephone Number	:	956-723-1230
Fax Number	:

Provider Business Practice Location Address
First Line	:	2439 MONARCH DR
Second Line	:	SUITE #4
City	:	LAREDO
State	:	TX
Zip	:	78045-6840
Country	:	US
Telephone Number	:	956-723-1230
Fax Number	:

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

Provider Enumeration Date	:	07/13/2011
Last Update Date	:	07/13/2015

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