Individual
DR. ALPHONSO L. MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
2 WINTONBURY MALL, BUILDING #5, BLOOMFIELD, CT 06002-2466
(860) 243-5451
(860) 656-6107
Mailing address
2 WINTONBURY MALL, BUILDING #5, BLOOMFIELD, CT 06002-2466
(860) 243-5451
(860) 656-6107
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
005845
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002058451 00
—
CT
Enumeration date
07/17/2006
Last updated
07/08/2007
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