Provider Demographics
NPI:1710980198
Name:BOTTY & DEVITO, D.D.S., L.L.P.
Entity Type:Organization
Organization Name:BOTTY & DEVITO, D.D.S., L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEVITO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-592-2400
Mailing Address - Street 1:633 W 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-3100
Mailing Address - Country:US
Mailing Address - Phone:315-592-2400
Mailing Address - Fax:315-592-2412
Practice Address - Street 1:633 W 3RD ST S
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-3100
Practice Address - Country:US
Practice Address - Phone:315-592-2400
Practice Address - Fax:315-592-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0411511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty