Provider Demographics
NPI:1326140385
Name:WARTELLA, DON GREGOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:GREGOR
Last Name:WARTELLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ROUTE 32A
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-3711
Mailing Address - Country:US
Mailing Address - Phone:518-678-3111
Mailing Address - Fax:
Practice Address - Street 1:33 ROUTE 32A
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-3711
Practice Address - Country:US
Practice Address - Phone:518-678-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0390331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00899610Medicaid