Healthcare Provider Details

I. General information

NPI: 1841467552
Provider Name (Legal Business Name): TIMOTHY JOSEPH VOTTA M.D., D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 W FERRY ST
BUFFALO NY
14222-1605
US

IV. Provider business mailing address

671 W FERRY ST
BUFFALO NY
14222-1605
US

V. Phone/Fax

Practice location:
  • Phone: 617-512-4780
  • Fax:
Mailing address:
  • Phone: 617-512-4780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number050946
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: