MEDICARE: DR. INGRID F PROENCA-AFONSO D.D.S.

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	122300000X	Dentist	23112	TX

General Provider Information

NPI Number	:	1407901903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INGRID F PROENCA-AFONSO D.D.S.

Provider Business Mailing Address
First Line	:	1232 WATERDOWN DR
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-5312
Country	:	US
Telephone Number	:	214-509-0722
Fax Number	:

Provider Business Practice Location Address
First Line	:	6031 SHERRY LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-6402
Country	:	US
Telephone Number	:	214-369-8585
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	02/05/2024

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Directions to “ DR. INGRID F PROENCA-AFONSO D.D.S.” Practice Location

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