Healthcare Provider Details

I. General information

NPI: 1538447404
Provider Name (Legal Business Name): PATRICK JOSEPH BATTISTA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 MAIN ST 240 RM
BUFFALO NY
14214-3001
US

IV. Provider business mailing address

18 SHANNON DR
LACKAWANNA NY
14218-3219
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-6225
  • Fax:
Mailing address:
  • Phone: 716-440-1275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number055073
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: