Healthcare Provider Details

I. General information

NPI: 1700446879
Provider Name (Legal Business Name): NATHALIA PAIVA DE ANDRADE DDS, MS, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 MAIN ST
BUFFALO NY
14214-3099
US

IV. Provider business mailing address

3435 MAIN ST
BUFFALO NY
14214-3099
US

V. Phone/Fax

Practice location:
  • Phone: 734-276-5810
  • Fax:
Mailing address:
  • Phone: 734-276-5810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2951000645
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number000169-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: