Provider Demographics
NPI:1558422956
Name:ALVARADO- ASTAIZA, JEANNIE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE
Middle Name:ELIZABETH
Last Name:ALVARADO- ASTAIZA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:ELIZABETH
Other - Last Name:ALVARADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3426 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2805
Mailing Address - Country:US
Mailing Address - Phone:516-783-9773
Mailing Address - Fax:516-783-9770
Practice Address - Street 1:3426 MERRICK RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2805
Practice Address - Country:US
Practice Address - Phone:516-783-9773
Practice Address - Fax:516-783-9770
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053016-11223G0001X
NY86801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02955948Medicaid