MEDICARE: DR. JOHN AVELINO DELCAMPO 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	027345	NY

General Provider Information

NPI Number	:	1770794281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN AVELINO DELCAMPO D.D.S.

Provider Business Mailing Address
First Line	:	49 HILLCREST DR
Second Line	:
City	:	ALFRED
State	:	NY
Zip	:	14802-1007
Country	:	US
Telephone Number	:	607-587-8838
Fax Number	:	607-587-9211

Provider Business Practice Location Address
First Line	:	49 HILLCREST DR
Second Line	:
City	:	ALFRED
State	:	NY
Zip	:	14802-1007
Country	:	US
Telephone Number	:	607-587-8838
Fax Number	:	607-587-9211

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	07/08/2007

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