Provider Demographics
NPI:1295890788
Name:HATALA, PETER ANTHONY (DDS)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:ANTHONY
Last Name:HATALA
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 1:1042 MITCHELL AVENUE
Mailing Address - Street 2:UNITED HEALTH SERVICES HOSPITALS DENTAL SERVICES
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903
Mailing Address - Country:US
Mailing Address - Phone:607-762-2006
Mailing Address - Fax:
Practice Address - Street 1:1042 MITCHELL AVENUE
Practice Address - Street 2:UNITED HEALTH SERVICES HOSPITALS DENTAL SERVICES
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903
Practice Address - Country:US
Practice Address - Phone:607-762-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050488122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist