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General NPI Number Information
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NPI Number | 1225181357
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Entity Type | Individual
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Provider Name | MARK RUSSELL ALVINO D.M.D
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Gender | Male
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Dates
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Enumeration Date | 01/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1134 TITUS AVE
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City | ROCHESTER
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State | NY
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Zip | 14617-4036
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Country | US
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Telephone | 585-266-4817
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Fax |
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Provider Business Mailing Address
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Address Line | 1134 TITUS AVE
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City | ROCHESTER
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State | NY
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Zip | 14617-4036
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Country | US
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Telephone | 585-266-4817
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 032661
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License Number State | NY
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