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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