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General NPI Number Information
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NPI Number | 1447252747
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Entity Type | Individual
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Provider Name | EMMANUEL BABATUNDE PUDDICOMBE DDS
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 295 MONROE AVE
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City | ROCHESTER
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State | NY
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Zip | 14607-3660
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Country | US
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Telephone | 585-467-4513
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Fax | 585-467-4665
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Provider Business Mailing Address
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Address Line | 8623 E. MAIN STREET PO BOX 559
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City | HONEOYE
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State | NY
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Zip | 14471
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Country | US
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Telephone | 585-229-2588
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Fax | 585-229-2496
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 053364
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License Number State | NY
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