MEDICARE: ALFONSO F PINEYRO DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	031743	NY

General Provider Information

NPI Number	:	1417177643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALFONSO F PINEYRO DDS PC

Provider Business Mailing Address
First Line	:	90 CANAL ST
Second Line	:	ALFONSO F PINEYRO DDS PC
City	:	FORT PLAIN
State	:	NY
Zip	:	13339
Country	:	US
Telephone Number	:	518-993-3023
Fax Number	:	218-993-3023

Provider Business Practice Location Address
First Line	:	90 CANAL ST
Second Line	:	ALFONSO F PINEYRO DDS PC
City	:	FORT PLAIN
State	:	NY
Zip	:	13339
Country	:	US
Telephone Number	:	518-993-3023
Fax Number	:	218-993-3023

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DR. RITA M PINEYRO
Credential	:
Telephone Number	:	518-993-3023

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	08/22/2020

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