Provider Demographics
NPI:1528272341
Name:ALFARO, DAVID WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WAYNE
Last Name:ALFARO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 LAKES DR
Mailing Address - Street 2:SUITE# 335
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2929
Mailing Address - Country:US
Mailing Address - Phone:626-338-9963
Mailing Address - Fax:626-856-3581
Practice Address - Street 1:1050 LAKES DR
Practice Address - Street 2:SUITE #335
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2929
Practice Address - Country:US
Practice Address - Phone:626-338-9963
Practice Address - Fax:626-856-3581
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice