Provider Demographics
NPI:1295871317
Name:HARBOTTLE, PAUL DANA (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DANA
Last Name:HARBOTTLE
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 1:681 TITICUS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10560-1801
Mailing Address - Country:US
Mailing Address - Phone:914-669-9626
Mailing Address - Fax:
Practice Address - Street 1:380 ROUTE 202
Practice Address - Street 2:SOMERS PROFESSIONAL COMMONS
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-3222
Practice Address - Country:US
Practice Address - Phone:914-277-3518
Practice Address - Fax:914-277-1020
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045872122300000X
CT009121122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist