Provider Demographics
NPI:1427119601
Name:NORTHTOWNS ORAL & MAXILLOFACIAL SURGERY, PLLC
Entity type:Organization
Organization Name:NORTHTOWNS ORAL & MAXILLOFACIAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:716-694-1134
Mailing Address - Street 1:57 DAVISON CT.
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094
Mailing Address - Country:US
Mailing Address - Phone:716-433-3822
Mailing Address - Fax:716-433-9337
Practice Address - Street 1:57 DAVISON CT.
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094
Practice Address - Country:US
Practice Address - Phone:716-433-3822
Practice Address - Fax:716-433-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty