Healthcare Provider Details

I. General information

NPI: 1609870963
Provider Name (Legal Business Name): HIRAN PERINPANAYAGAM D.D.S., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 BRYANT ST
BUFFALO NY
14222-2006
US

IV. Provider business mailing address

40 DEVILLE CIR
AMHERST NY
14221-4408
US

V. Phone/Fax

Practice location:
  • Phone: 716-878-7514
  • Fax:
Mailing address:
  • Phone: 716-864-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number047484
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: