Provider Demographics
NPI:1487746707
Name:ALBERT, JOHN G (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:ALBERT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7242 OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-3719
Mailing Address - Country:US
Mailing Address - Phone:315-451-7151
Mailing Address - Fax:315-461-9222
Practice Address - Street 1:7242 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-3719
Practice Address - Country:US
Practice Address - Phone:315-451-7151
Practice Address - Fax:315-461-9222
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0351811223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics