MEDICARE: DR. MICHAEL VATRAL DDSMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	043590	NY

General Provider Information

NPI Number	:	1548330889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL VATRAL DDSMS

Provider Business Mailing Address
First Line	:	6225 W QUAKER ST
Second Line	:
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-2641
Country	:	US
Telephone Number	:	716-667-2030
Fax Number	:	716-667-2034

Provider Business Practice Location Address
First Line	:	6225 W QUAKER ST
Second Line	:
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-2641
Country	:	US
Telephone Number	:	716-667-2030
Fax Number	:	716-667-2034

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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