Healthcare Provider Details

I. General information

NPI: 1275451155
Provider Name (Legal Business Name): THALITA REGINA VIEIRA E OLIVEIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 SQUIRE HALL
BUFFALO NY
14214-8006
US

IV. Provider business mailing address

114 SQUIRE HALL
BUFFALO NY
14214
US

V. Phone/Fax

Practice location:
  • Phone: 716-329-0253
  • Fax:
Mailing address:
  • Phone: 716-829-6339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0172
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: