Healthcare Provider Details

I. General information

NPI: 1841272796
Provider Name (Legal Business Name): ALAN IRA YALLOWITZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 GARDEN ST
LITTLE FALLS NY
13365-1405
US

IV. Provider business mailing address

513 GARDEN ST
LITTLE FALLS NY
13365-1405
US

V. Phone/Fax

Practice location:
  • Phone: 315-823-3570
  • Fax: 315-823-1432
Mailing address:
  • Phone: 315-823-3570
  • Fax: 315-823-1432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number044482
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: