Provider Demographics
NPI:1831329200
Name:BOTEZATU, VLAD (DMD)
Entity type:Individual
Prefix:DR
First Name:VLAD
Middle Name:
Last Name:BOTEZATU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 RESERVOIR AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4452
Mailing Address - Country:US
Mailing Address - Phone:401-400-8868
Mailing Address - Fax:401-406-2710
Practice Address - Street 1:725 RESERVOIR AVE STE 304
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4452
Practice Address - Country:US
Practice Address - Phone:401-400-8868
Practice Address - Fax:401-406-2710
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028082122300000X
RIDEN030981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist