Healthcare Provider Details

I. General information

NPI: 1891846515
Provider Name (Legal Business Name): RICHARD OHRBACH PHD, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 MAIN ST 355 SQUIRE HALL
BUFFALO NY
14214-3001
US

IV. Provider business mailing address

3435 MAIN ST 355 SQUIRE HALL
BUFFALO NY
14214-3001
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-3590
  • Fax: 716-829-3554
Mailing address:
  • Phone: 716-829-3590
  • Fax: 716-829-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number013564-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number045850-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number45850-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: