Provider Demographics
NPI:1932431582
Name:BUENO, ALTAGRACIA RAFAELA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ALTAGRACIA
Middle Name:RAFAELA
Last Name:BUENO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:ALTAGRACIA
Other - Middle Name:RAFAELA
Other - Last Name:BUENO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:144-15 JAMAICA AVENUE JAMAICA
Mailing Address - Street 2:
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11435
Mailing Address - Country:US
Mailing Address - Phone:718-655-9811
Mailing Address - Fax:718-657-9799
Practice Address - Street 1:144-15 JAMAICA AVENUE JAMAICA
Practice Address - Street 2:
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11435
Practice Address - Country:US
Practice Address - Phone:718-655-9811
Practice Address - Fax:718-657-9799
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045562-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist