MEDICARE: DR. STEPHEN GLEN ALFANO DDS

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	DS039820	PA
2	1223P0700X	Prosthodontics	17058	TX
3	122300000X	Dentist	56564	CA

General Provider Information

NPI Number	:	1427045236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN GLEN ALFANO DDS

Provider Business Mailing Address
First Line	:	217 MARINE AVE STE A
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92662-1289
Country	:	US
Telephone Number	:	949-673-7820
Fax Number	:	949-673-6682

Provider Business Practice Location Address
First Line	:	217 MARINE AVE STE A
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92662-1289
Country	:	US
Telephone Number	:	949-673-7820
Fax Number	:	949-673-6682

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	02/28/2023

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