Provider Demographics
NPI:1528745486
Name:AFONSO, MICHELLE (DMD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:AFONSO
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 1:9067 ARNDALE CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1529
Mailing Address - Country:US
Mailing Address - Phone:813-326-2909
Mailing Address - Fax:
Practice Address - Street 1:213 KINGSWAY RD STE B
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4637
Practice Address - Country:US
Practice Address - Phone:813-689-4226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN280921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice