Healthcare Provider Details

I. General information

NPI: 1184936080
Provider Name (Legal Business Name): HEMA PRAVEEN ARANY BDS, MDS, CAGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEMA SHIVYOGEPPA BAGALKOTI BDS, MDS, CAGS

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 MAIN ST 215 SQUIRE HALL
BUFFALO NY
14214-3001
US

IV. Provider business mailing address

23 EMERALD TRL
BUFFALO NY
14221-8333
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-2862
  • Fax:
Mailing address:
  • Phone: 617-821-5499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number000074
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: