Individual
DR. KATHLEEN D BALTHASAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
155 LAWN AVE, BUFFALO, NY 14207-1816
(716) 875-2904
(716) 875-6717
Mailing address
155 LAWN AVE, BUFFALO, NY 14207-1816
(716) 875-2904
(716) 875-6717
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
044862-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00075551300
BC/BS
NY
01
—
10596
DORAL
NY
01
—
400151
INDEPENDENT HEALTH
NY
01
—
722046
AETNA
NY
Enumeration date
10/04/2006
Last updated
11/13/2015
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