MEDICARE: DR. PAMELA ANN GAMBACORTA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	047505-1	NY

General Provider Information

NPI Number	:	1023165636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA ANN GAMBACORTA D.D.S.

Provider Business Mailing Address
First Line	:	4060 FOXWOOD LN
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-7370
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3714 ABBOTT RD
Second Line	:
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-1713
Country	:	US
Telephone Number	:	716-823-1993
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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