Provider Demographics
NPI:1699070342
Name:ALBORNOZ, EDUARDO E (DDS)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:E
Last Name:ALBORNOZ
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 1:130 BARBER ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-5041
Mailing Address - Country:US
Mailing Address - Phone:631-951-3214
Mailing Address - Fax:
Practice Address - Street 1:130 BARBER ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-5041
Practice Address - Country:US
Practice Address - Phone:631-951-3214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035655122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist