| O. Boyce Mcdivitt,dds | |
|
149 S Main St Portville NY 14770-9703 | |
| (716) 933-6787 | |
| (716) 933-0117 |
| Full Name | O. Boyce Mcdivitt,dds |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 149 S Main St, Portville, New York |
| Authorized Official Name and Position | Olin Boyce Mcdivitt (OWNER) |
| Authorized Official Contact | 7169336787 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| O. Boyce Mcdivitt,dds 149 S Main St Portville NY 14770-9703 Ph: (716) 933-6787 | O. Boyce Mcdivitt,dds 149 S Main St Portville NY 14770-9703 Ph: (716) 933-6787 |
| NPI Number | 1740494137 |
|---|---|
| Provider Enumeration Date | 05/09/2007 |
| Last Update Date | 06/15/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740494137 | NPI | - | NPPES |
| 0005536000001 | Medicaid | PA | |
| 1962490987 | Other | MCDIVITT NPI | |
| 02386001NY | Medicaid | NY | |
| 1407844426 | Other | PETRYSZAK NPI | |
| 00605445NY | Medicaid | NY | |
| 007700991 | Other | MCDIVITT BC BS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 1223G0001X (New York) | Primary |
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