Provider Demographics
NPI:1225181357
Name:ALVINO, MARK RUSSELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RUSSELL
Last Name:ALVINO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 TITUS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-4036
Mailing Address - Country:US
Mailing Address - Phone:585-266-4817
Mailing Address - Fax:
Practice Address - Street 1:1134 TITUS AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-4036
Practice Address - Country:US
Practice Address - Phone:585-266-4817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0326611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice