Provider Demographics
NPI:1699785352
Name:CATLIN, JOHN WALTER (DSS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WALTER
Last Name:CATLIN
Suffix:
Gender:M
Credentials:DSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 E FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14750-1812
Mailing Address - Country:US
Mailing Address - Phone:716-763-9838
Mailing Address - Fax:716-763-6016
Practice Address - Street 1:70 E FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NY
Practice Address - Zip Code:14750-1812
Practice Address - Country:US
Practice Address - Phone:716-763-9838
Practice Address - Fax:716-763-6016
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029192122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist