MEDICARE: DR. JOSEPH M PILATICH III D.D.S.

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	1223G0001X	General Practice Dentistry	044630	NY

General Provider Information

NPI Number	:	1760695571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH M PILATICH III D.D.S.

Provider Business Mailing Address
First Line	:	132 JEFFERSON HTS
Second Line	:
City	:	CATSKILL
State	:	NY
Zip	:	12414-1215
Country	:	US
Telephone Number	:	518-943-0920
Fax Number	:	518-943-0921

Provider Business Practice Location Address
First Line	:	132 JEFFERSON HTS
Second Line	:
City	:	CATSKILL
State	:	NY
Zip	:	12414-1215
Country	:	US
Telephone Number	:	518-943-0920
Fax Number	:	518-943-0921

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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