Provider Demographics
NPI:1659446649
Name:MECHTLER, KATALIN MONIKA (DDS)
Entity Type:Individual
Prefix:
First Name:KATALIN
Middle Name:MONIKA
Last Name:MECHTLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6507 WHEELER RD
Mailing Address - Street 2:FOUNDERS HEALTH
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9416
Mailing Address - Country:US
Mailing Address - Phone:716-439-0477
Mailing Address - Fax:716-439-0067
Practice Address - Street 1:6507 WHEELER RD
Practice Address - Street 2:FOUNDERS HEALTH
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9416
Practice Address - Country:US
Practice Address - Phone:716-439-0477
Practice Address - Fax:716-439-0067
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0012766OtherDORAL DENTAL