Healthcare Provider Details

I. General information

NPI: 1093849770
Provider Name (Legal Business Name): WILLIAM F. ALFONSO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CRESTWOOD RD STE. 302
NORTH LITTLE ROCK AR
72116-6864
US

IV. Provider business mailing address

2501 CRESTWOOD RD STE. 302
NORTH LITTLE ROCK AR
72116-6864
US

V. Phone/Fax

Practice location:
  • Phone: 501-771-4631
  • Fax: 501-771-4682
Mailing address:
  • Phone: 501-771-4631
  • Fax: 501-771-4682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS2246
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: