Provider Demographics
NPI:1598827677
Name:ALFARO, WALESKA D (DMD)
Entity type:Individual
Prefix:DR
First Name:WALESKA
Middle Name:D
Last Name:ALFARO
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 1:2350 BELMONT CIR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-1568
Mailing Address - Country:US
Mailing Address - Phone:404-843-3011
Mailing Address - Fax:
Practice Address - Street 1:2350 BELMONT CIR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-1568
Practice Address - Country:US
Practice Address - Phone:404-843-3011
Practice Address - Fax:678-842-9913
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0121551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9180133OtherDORAL PROVIDER NUMBER
GA100759OtherAVESIS PROVIDER NUMBER