Provider Demographics
NPI:1497946412
Name:BATAVIA ESTHETIC DENTISTRY
Entity Type:Organization
Organization Name:BATAVIA ESTHETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIMAL
Authorized Official - Middle Name:VLADIMIR
Authorized Official - Last Name:FRIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-343-1958
Mailing Address - Street 1:413 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-2437
Mailing Address - Country:US
Mailing Address - Phone:585-343-1958
Mailing Address - Fax:585-343-0111
Practice Address - Street 1:413 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2437
Practice Address - Country:US
Practice Address - Phone:585-343-1958
Practice Address - Fax:585-343-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0501751223G0001X
NY0506561223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty