Healthcare Provider Details

I. General information

NPI: 1699090928
Provider Name (Legal Business Name): MICHAEL B QUIGLEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 AMHERST ST APT # 4
BUFFALO NY
14216-3546
US

IV. Provider business mailing address

8016 E GENESEE ST
FAYETTEVILLE NY
13066-9692
US

V. Phone/Fax

Practice location:
  • Phone: 716-207-9417
  • Fax:
Mailing address:
  • Phone: 315-637-6961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number055466-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: