MEDICARE: DR. STEVEN ESPOSITO D.M.D.

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	1223G0001X	General Practice Dentistry	38696	NY

General Provider Information

NPI Number	:	1619970373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN ESPOSITO D.M.D.

Provider Business Mailing Address
First Line	:	204 MALTA AVE
Second Line	:
City	:	BALLSTON SPA
State	:	NY
Zip	:	12020-1505
Country	:	US
Telephone Number	:	518-885-5010
Fax Number	:	518-885-4649

Provider Business Practice Location Address
First Line	:	204 MALTA AVE
Second Line	:
City	:	BALLSTON SPA
State	:	NY
Zip	:	12020-1505
Country	:	US
Telephone Number	:	518-885-5010
Fax Number	:	518-885-4649

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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