Provider Demographics
NPI:1710346390
Name:BATH DENTAL PROFESSIONALS, LLP
Entity Type:Organization
Organization Name:BATH DENTAL PROFESSIONALS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-335-2201
Mailing Address - Street 1:113 E STEUBEN ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1621
Mailing Address - Country:US
Mailing Address - Phone:607-776-2116
Mailing Address - Fax:
Practice Address - Street 1:113 E STEUBEN ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1621
Practice Address - Country:US
Practice Address - Phone:607-776-2116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DANSVILLE DENTAL PROFESSIONALS, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty