Provider Demographics
NPI:1285708669
Name:BOCHACKI, VICTOR ANTHONY (DMD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ANTHONY
Last Name:BOCHACKI
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 1:132 BURBANK DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2383
Mailing Address - Country:US
Mailing Address - Phone:716-667-3412
Mailing Address - Fax:
Practice Address - Street 1:22 S BUFFALO ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1239
Practice Address - Country:US
Practice Address - Phone:716-592-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040655-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01006968Medicaid