Healthcare Provider Details

I. General information

NPI: 1013837541
Provider Name (Legal Business Name): ALEGNA ALFONSO DE LA LUZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 SW 80TH ST
MIAMI FL
33173-3603
US

IV. Provider business mailing address

11500 SW 80TH ST
MIAMI FL
33173-3603
US

V. Phone/Fax

Practice location:
  • Phone: 786-580-2581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32266
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: