MEDICARE: DR. JOHN EDWARD AGOSTINELLI D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	33130	NY

General Provider Information

NPI Number	:	1336240712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN EDWARD AGOSTINELLI D.D.S

Provider Business Mailing Address
First Line	:	3770 MOUNT READ BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14616-3436
Country	:	US
Telephone Number	:	585-865-7030
Fax Number	:	585-865-1425

Provider Business Practice Location Address
First Line	:	3770 MOUNT READ BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14616-3436
Country	:	US
Telephone Number	:	585-865-7030
Fax Number	:	585-865-1425

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	01/05/2016

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