Provider Demographics
NPI:1528261575
Name:PANIAGUA, ALYCE (DMD)
Entity type:Individual
Prefix:DR
First Name:ALYCE
Middle Name:
Last Name:PANIAGUA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 GRIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507-1810
Mailing Address - Country:US
Mailing Address - Phone:914-241-9205
Mailing Address - Fax:914-242-9220
Practice Address - Street 1:64 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD HILLS
Practice Address - State:NY
Practice Address - Zip Code:10507-1810
Practice Address - Country:US
Practice Address - Phone:914-241-9205
Practice Address - Fax:914-242-9220
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043513122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist