Healthcare Provider Details

I. General information

NPI: 1689362394
Provider Name (Legal Business Name): KYLE JOSEPH HASTINGS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4233 MAPLE RD
AMHERST NY
14226-1039
US

IV. Provider business mailing address

4233 MAPLE RD
AMHERST NY
14226-1039
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-2728
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number064168
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: