Healthcare Provider Details

I. General information

NPI: 1760619480
Provider Name (Legal Business Name): CARRIE ANN WANAMAKER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2009
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 E MAIN ST
BATAVIA NY
14020-2437
US

IV. Provider business mailing address

4775 SHERIDAN DR
WILLIAMSVILLE NY
14221-4434
US

V. Phone/Fax

Practice location:
  • Phone: 585-343-1900
  • Fax:
Mailing address:
  • Phone: 716-572-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberP69828
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: