Individual
DR. ROOSEVELT ALFONSO DANIEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
524 E EDGEMONT AVE, MONTGOMERY, AL 36111-1321
(334) 834-9647
(334) 834-3716
Mailing address
118 N HAARDT DR, MONTGOMERY, AL 36105-1646
(334) 834-4188
(334) 834-9647
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3328
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000091556
—
AL
01
—
51091556
BCBSAL
AL
Enumeration date
03/15/2007
Last updated
07/08/2007
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