Provider Demographics
NPI:1447252747
Name:PUDDICOMBE, EMMANUEL BABATUNDE (DDS)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:BABATUNDE
Last Name:PUDDICOMBE
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 1:8623 E. MAIN STREET
Mailing Address - Street 2:PO BOX 559
Mailing Address - City:HONEOYE
Mailing Address - State:NY
Mailing Address - Zip Code:14471
Mailing Address - Country:US
Mailing Address - Phone:585-229-2588
Mailing Address - Fax:585-229-2496
Practice Address - Street 1:295 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-3660
Practice Address - Country:US
Practice Address - Phone:585-467-4513
Practice Address - Fax:585-467-4665
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053364122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02605329Medicaid