MEDICARE: DR. EMMANUEL LINGAD ALFONSO 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	1223G0001X	General Practice Dentistry	38246	CA

General Provider Information

NPI Number	:	1831150150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMMANUEL LINGAD ALFONSO D.D.S.

Provider Business Mailing Address
First Line	:	15940 AMAR RD
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91744-2201
Country	:	US
Telephone Number	:	626-336-3404
Fax Number	:	626-330-3542

Provider Business Practice Location Address
First Line	:	15940 AMAR RD
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91744-2201
Country	:	US
Telephone Number	:	626-336-3404
Fax Number	:	626-330-3542

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	10/14/2008

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