Healthcare Provider Details

I. General information

NPI: 1023197456
Provider Name (Legal Business Name): VLADIMIR FRIAS D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2006
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON STREETS
BUFFA;P NY
14263
US

IV. Provider business mailing address

ELM AND CARLTON STREETS
BUFFALO NY
14263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-2300
  • Fax: 716-845-3056
Mailing address:
  • Phone: 718-845-2300
  • Fax: 716-845-3056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number050656
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: