MEDICARE: DR. ALFONSO LIMONE DMD

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	22D101842800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	203968891	OTHER	NJ	TAX ID

General Provider Information

NPI Number	:	1225182538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFONSO LIMONE DMD

Provider Business Mailing Address
First Line	:	6 W SPRUCE ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5007
Country	:	US
Telephone Number	:	732-364-5100
Fax Number	:	732-612-1041

Provider Business Practice Location Address
First Line	:	6 W SPRUCE ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5007
Country	:	US
Telephone Number	:	732-364-5100
Fax Number	:	732-612-1041

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	10/20/2015

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