Healthcare Provider Details

I. General information

NPI: 1962548099
Provider Name (Legal Business Name): ALYSON MARIE ESPOSITO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 GREAT NECK RD
COPIAGUE NY
11726-3101
US

IV. Provider business mailing address

1605 GREAT NECK RD
COPIAGUE NY
11726-3101
US

V. Phone/Fax

Practice location:
  • Phone: 631-842-1465
  • Fax: 631-789-4640
Mailing address:
  • Phone: 631-842-1465
  • Fax: 631-789-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number049032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: