Healthcare Provider Details

I. General information

NPI: 1548330889
Provider Name (Legal Business Name): MICHAEL VATRAL DDSMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 W QUAKER ST
ORCHARD PARK NY
14127-2641
US

IV. Provider business mailing address

6225 W QUAKER ST
ORCHARD PARK NY
14127-2641
US

V. Phone/Fax

Practice location:
  • Phone: 716-667-2030
  • Fax: 716-667-2034
Mailing address:
  • Phone: 716-667-2030
  • Fax: 716-667-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number043590
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: