MEDICARE: DR. ALFONSO J MELEAN D.M.D.

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	DN-14205	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609845031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFONSO J MELEAN D.M.D.

Provider Business Mailing Address
First Line	:	4802 E 7TH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-4704
Country	:	US
Telephone Number	:	813-248-8515
Fax Number	:	813-241-2709

Provider Business Practice Location Address
First Line	:	4802 E 7TH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-4704
Country	:	US
Telephone Number	:	813-248-8515
Fax Number	:	813-241-2709

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	09/12/2011

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