Healthcare Provider Details

I. General information

NPI: 1770031999
Provider Name (Legal Business Name): MINDY ALTEMOSE DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W HENRIETTA RD
ROCHESTER NY
14623-3543
US

IV. Provider business mailing address

14 AMBASSADOR DR
VICTOR NY
14564-1204
US

V. Phone/Fax

Practice location:
  • Phone: 585-427-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number058729
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: