Healthcare Provider Details

I. General information

NPI: 1245669217
Provider Name (Legal Business Name): MCCLURE DENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2013
Last Update Date: 11/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 EGGERT RD
BUFFALO NY
14226-2139
US

IV. Provider business mailing address

2000 EGGERT RD
BUFFALO NY
14226-2139
US

V. Phone/Fax

Practice location:
  • Phone: 716-250-8751
  • Fax:
Mailing address:
  • Phone: 716-250-8751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number037529-1
License Number StateNY

VIII. Authorized Official

Name: MR. JEREMY JAMES SIEPIERSKI
Title or Position: COO
Credential:
Phone: 716-250-8751