Healthcare Provider Details

I. General information

NPI: 1760536551
Provider Name (Legal Business Name): SANIL BALKRISHNA NIGALYE D.D.S., M.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 MAIN STREET SQUIRE HALL UNIVERSITY AT BUFFALO
BUFFALO NY
14214-3013
US

IV. Provider business mailing address

6622 MAIN ST STE 4
WILLIAMSVILLE NY
14221-5968
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-2722
  • Fax:
Mailing address:
  • Phone: 716-276-3553
  • Fax: 716-276-3552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number049563-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: