Provider Demographics
NPI:1669777389
Name:NICHOLAS J SCHELLATI DDS PLLC
Entity type:Organization
Organization Name:NICHOLAS J SCHELLATI DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT BILLING
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRESHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-848-7974
Mailing Address - Street 1:6534 ANTHONY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1403
Mailing Address - Country:US
Mailing Address - Phone:877-667-7669
Mailing Address - Fax:405-848-0033
Practice Address - Street 1:3000 UNITED FOUNDERS BLVD
Practice Address - Street 2:SUITE 237
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3958
Practice Address - Country:US
Practice Address - Phone:405-848-7974
Practice Address - Fax:405-848-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0527371223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty