Healthcare Provider Details

I. General information

NPI: 1972565067
Provider Name (Legal Business Name): ALVIN FRANCIS DESIENA D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 WATERVLIET SHAKER RD
ALBANY NY
12205-2114
US

IV. Provider business mailing address

1016 WATERVLIET SHAKER RD
ALBANY NY
12205-2114
US

V. Phone/Fax

Practice location:
  • Phone: 518-869-3114
  • Fax: 518-869-6983
Mailing address:
  • Phone: 518-869-3114
  • Fax: 518-869-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number028451
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: