Healthcare Provider Details

I. General information

NPI: 1518792068
Provider Name (Legal Business Name): BUFFALO DENTAL SMILE DESIGN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 HOPKINS RD
BUFFALO NY
14221-4641
US

IV. Provider business mailing address

175 HUMBOLDT ST STE 100
ROCHESTER NY
14610-1058
US

V. Phone/Fax

Practice location:
  • Phone: 716-406-0600
  • Fax:
Mailing address:
  • Phone: 585-319-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: FRANK LAMAR
Title or Position: CEO, FOUNDER
Credential:
Phone: 585-738-6650