Michael J. Botty, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

031849 Issued in NY

Practice address

633 W 3Rd St S
Fulton, NY 13069-3100

Phone

(315) 592-2400

Fax

(315) 592-2412

NPI assigned

May 31, 2005

Reactivated

Mar 25, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Botty & Devito, D.D.S., L.L.P.

  • General Practice Dentistry
  • Fulton, NY
  • NPI 1710980198

  General Practice

  NPD (past)
• Great Lakes Oral Surgery, P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Fulton, NY
  • NPI 1174858419
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1033112412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 W 3RD ST S",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "130693100",
            "telephone_number": "315-592-2400",
            "fax_number": "315-592-2412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 W 3RD ST S",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "130693100",
            "telephone_number": "315-592-2400",
            "fax_number": "315-592-2412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTTY",
        "first_name": "MICHAEL",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-31",
        "last_updated": "2026-07-13",
        "deactivation_date": "2006-03-17",
        "reactivation_date": "2006-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "031849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00461138",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beyond Words Healing Services LLC
• Kori L Birchenough, D.C.
• Jennifer Lynn Blake, LMHC
• Diane Blasczienski
• Botty & Devito, D.D.S., L.L.P.
• Paula M Bourgeois, LPN
• Deneen D Bowman, FNP
• Gary Douglas Bozeman, M.D.
• Michael Joseph Branish, RPH
• Rebekah June Braunlich, PHYSICIAN ASSISTANT

• All providers in Fulton, NY
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.