Individual
DR. MARIO E ALFONSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
7085 SWINNEA RD, SUITE A, SOUTHAVEN, MS 38671-6001
(662) 349-3038
(662) 349-3051
Mailing address
7085 SWINNEA RD, SUITE A, SOUTHAVEN, MS 38671-6001
(662) 349-3038
(662) 349-3051
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
MS2062-84
MS
Other
Enumeration date
08/08/2006
Last updated
07/08/2007
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