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General NPI Number Information
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NPI Number | 1497946412
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Entity Type | Organization
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Legal Business Name | BATAVIA ESTHETIC DENTISTRY
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 413 E MAIN ST
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City | BATAVIA
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State | NY
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Zip | 14020-2437
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Country | US
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Telephone | 585-343-1958
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Fax | 585-343-0111
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Provider Business Mailing Address
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Address Line | 413 E MAIN ST
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City | BATAVIA
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State | NY
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Zip | 14020-2437
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Country | US
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Telephone | 585-343-1958
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Fax | 585-343-0111
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Authorized Official
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Title or Position | PARTNER
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Name | DR. VIMAL VLADIMIR FRIAS
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Credential | D.D.S
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Telephone | 585-343-1958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 050175
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 050656
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License Number State | NY
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