Provider Demographics
NPI:1962490987
Name:MCDIVITT, O BOYCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:O
Middle Name:BOYCE
Last Name:MCDIVITT
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 1:149 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14770-9703
Mailing Address - Country:US
Mailing Address - Phone:716-933-6787
Mailing Address - Fax:716-933-6933
Practice Address - Street 1:149 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14770-9703
Practice Address - Country:US
Practice Address - Phone:716-933-6787
Practice Address - Fax:716-933-6933
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY0270641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00605445Medicaid
NY3327064OtherDELTA