Healthcare Provider Details

I. General information

NPI: 1679376255
Provider Name (Legal Business Name): PAUL DIMARZO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST
BUFFALO NY
14215-3098
US

IV. Provider business mailing address

150 HILARY ST
OAKDALE NY
11769-1813
US

V. Phone/Fax

Practice location:
  • Phone: 631-627-0638
  • Fax:
Mailing address:
  • Phone: 631-627-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number065485
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: