MEDICARE: AESTHETIC ORAL ARTS, PLLC

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	261QD0000X	Dental Clinic/Center	38859	NY

General Provider Information

NPI Number	:	1790290294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AESTHETIC ORAL ARTS, PLLC

Provider Business Mailing Address
First Line	:	4388 MIDDLE SETTLEMENT RD
Second Line	:
City	:	NEW HARTFORD
State	:	NY
Zip	:	13413-5316
Country	:	US
Telephone Number	:	315-724-7121
Fax Number	:

Provider Business Practice Location Address
First Line	:	4388 MIDDLE SETTLEMENT RD
Second Line	:
City	:	NEW HARTFORD
State	:	NY
Zip	:	13413-5316
Country	:	US
Telephone Number	:	315-724-7121
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TIMOTHY ALLEN PFISTER
Credential	:	DMD
Telephone Number	:	315-724-7121

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	12/06/2017

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