Healthcare Provider Details

I. General information

NPI: 1710397286
Provider Name (Legal Business Name): COLLEEN LACOMBE-SENECAL D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 SQUIRE HALL
BUFFALO NY
14214-8006
US

IV. Provider business mailing address

114 SQUIRE HALL
BUFFALO NY
14214-8006
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-3717
  • Fax:
Mailing address:
  • Phone: 716-829-3717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number058688-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: