Healthcare Provider Details

I. General information

NPI: 1609570092
Provider Name (Legal Business Name): BUFFALO ORAL SURGERY SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 LINWOOD AVE
BUFFALO NY
14209-2003
US

IV. Provider business mailing address

117 LINWOOD AVE
BUFFALO NY
14209-2003
US

V. Phone/Fax

Practice location:
  • Phone: 716-882-6333
  • Fax: 716-882-0891
Mailing address:
  • Phone: 716-882-6333
  • Fax: 716-882-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW BRACCI
Title or Position: CLINICAL COORDINATOR
Credential: DMD
Phone: 312-502-1292