Basic Information
| Provider Information | |||||||||
| NPI: | 1780850842 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRECIADO | ||||||||
| FirstName: | ALVARO | ||||||||
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| Credential: | D.D.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214-30 46 AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | BAYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3472354100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 447 FULTON ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112015207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188753200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2008 | ||||||||
| LastUpdateDate: | 02/12/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DN17714 | FL | N | Dental Providers | Dentist | General Practice | 1223G0001X | 053108 | NY | Y | Dental Providers | Dentist | General Practice | 1223G0001X | 009702 | CT | N | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 02802748 | 05 | NY | MEDICAID |