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Organization
THE GREEN DENTAL STUDIO PA
Active
Organization
THE GREEN DENTAL STUDIO PA
Active
Other names
The Green Dental Studio
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE ANTONIO ALFONSO DMD (OWNER)
(786) 614-8927
Entity
Organization
Contact information
Practice address
1330 SE 4TH AVE STE L, FORT LAUDERDALE, FL 33316-1958
(954) 990-8389
Mailing address
1330 SE 4TH AVE STE L, FORT LAUDERDALE, FL 33316-1958
(954) 990-8389
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760008486
—
NJ
Enumeration date
02/02/2023
Last updated
02/02/2023
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