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General NPI Number Information
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NPI Number | 1346460300
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Entity Type | Individual
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Provider Name | ALFONSO LUIS PATRON DDS
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 505 HUNTMAR PARK DR STE 150
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City | HERNDON
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State | VA
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Zip | 20170-5139
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Country | US
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Telephone | 703-736-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 MASSACHUSETTS AVE NW APT 719
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City | WASHINGTON
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State | DC
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Zip | 20005-5320
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Country | US
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Telephone | 267-265-2265
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 0401411192
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License Number State | VA
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