Organization
SUBURBAN ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT BAVISOTTO DDS (ORTHODONTIST)
(716) 649-5254
Entity
Organization
Contact information
Practice address
2005 NIAGARA FALLS BLVD, AMHERST, NY 14228-3520
(716) 568-8044
(716) 649-1516
Mailing address
2005 NIAGARA FALLS BLVD, AMHERST, NY 14228-3520
(716) 568-8044
(716) 649-1516
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
0321781
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01369268
—
NY
Enumeration date
04/23/2008
Last updated
11/03/2009
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