Provider Demographics
NPI:1194812826
Name:ALON-ALON, MARY ROSE A (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY ROSE
Middle Name:A
Last Name:ALON-ALON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 KINGSLEY AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4560
Mailing Address - Country:US
Mailing Address - Phone:904-215-2199
Mailing Address - Fax:904-215-2188
Practice Address - Street 1:1555 KINGSLEY AVENUE
Practice Address - Street 2:SUITE 306
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-9203
Practice Address - Country:US
Practice Address - Phone:904-215-2199
Practice Address - Fax:904-215-2188
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDNOO147081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice