Provider Demographics
NPI:1053573337
Name:MOTTOLESE, PATRICK J (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:MOTTOLESE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ATRIUM DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1417
Mailing Address - Country:US
Mailing Address - Phone:518-459-4390
Mailing Address - Fax:
Practice Address - Street 1:3 ATRIUM DR
Practice Address - Street 2:SUITE 215
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1417
Practice Address - Country:US
Practice Address - Phone:518-459-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0398411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice