Healthcare Provider Details

I. General information

NPI: 1932431582
Provider Name (Legal Business Name): ALTAGRACIA RAFAELA BUENO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALTAGRACIA RAFAELA BUENO DDS

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144-15 JAMAICA AVENUE JAMAICA
QUEENS NY
11435
US

IV. Provider business mailing address

144-15 JAMAICA AVENUE JAMAICA
QUEENS NY
11435
US

V. Phone/Fax

Practice location:
  • Phone: 718-655-9811
  • Fax: 718-657-9799
Mailing address:
  • Phone: 718-655-9811
  • Fax: 718-657-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number045562-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: