Healthcare Provider Details

I. General information

NPI: 1710971536
Provider Name (Legal Business Name): STUART LEE FISCHMAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 SQUIRE HALL 3435 MAIN STREET
BUFFALO NY
14214-8006
US

IV. Provider business mailing address

355 SQUIRE HALL 3435 MAIN STREET
BUFFALO NY
14214-8006
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-3556
  • Fax: 716-829-3554
Mailing address:
  • Phone: 716-829-3556
  • Fax: 716-829-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number022760
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: