Provider Demographics
NPI:1831112267
Name:BARLETTA, DANIEL PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PAUL
Last Name:BARLETTA
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 1:1101 ENGLISH RD.
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-2029
Mailing Address - Country:US
Mailing Address - Phone:585-227-4900
Mailing Address - Fax:585-225-7073
Practice Address - Street 1:1101 ENGLISH RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-2029
Practice Address - Country:US
Practice Address - Phone:585-227-4900
Practice Address - Fax:585-225-7073
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038149-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1612322066OtherNYS TAX COLLECTION NUMBER
NY038149-1OtherNYS DENTAL LICENSE
NY00852740Medicaid