MEDICARE: ALVIN FRANCIS DESIENA 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	028451	NY

General Provider Information

NPI Number	:	1972565067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALVIN FRANCIS DESIENA D.M.D.

Provider Business Mailing Address
First Line	:	1016 WATERVLIET SHAKER RD
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-2114
Country	:	US
Telephone Number	:	518-869-3114
Fax Number	:	518-869-6983

Provider Business Practice Location Address
First Line	:	1016 WATERVLIET SHAKER RD
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-2114
Country	:	US
Telephone Number	:	518-869-3114
Fax Number	:	518-869-6983

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	07/08/2007

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