Provider Demographics
NPI:1023030921
Name:MORINI, ALFRED JOHN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:JOHN
Last Name:MORINI
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-2427
Mailing Address - Country:US
Mailing Address - Phone:518-842-2118
Mailing Address - Fax:518-843-7071
Practice Address - Street 1:106 MARKET ST
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-4421
Practice Address - Country:US
Practice Address - Phone:518-843-2191
Practice Address - Fax:518-843-7071
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036055122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02253309Medicaid