Provider Demographics
NPI:1235102237
Name:LIOTTA, ALBERT LOUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:LOUIS
Last Name:LIOTTA
Suffix:
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 1:199 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4601
Mailing Address - Country:US
Mailing Address - Phone:631-368-3709
Mailing Address - Fax:631-368-3709
Practice Address - Street 1:199 CEDAR RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4601
Practice Address - Country:US
Practice Address - Phone:631-368-3709
Practice Address - Fax:631-368-3709
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0345991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice