Provider Demographics
NPI:1447487350
Name:ALFUENTE, ELIZABETH ROSE (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ROSE
Last Name:ALFUENTE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 BAY ISLAND CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3954
Mailing Address - Country:US
Mailing Address - Phone:352-219-3038
Mailing Address - Fax:
Practice Address - Street 1:12777 ATLANTIC BLVD
Practice Address - Street 2:SUITE 26
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7120
Practice Address - Country:US
Practice Address - Phone:904-221-3550
Practice Address - Fax:904-221-3227
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN186281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice