Healthcare Provider Details

I. General information

NPI: 1033764741
Provider Name (Legal Business Name): JACQUELINE SZCZUPAKOWSKI DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9736 TRANSIT RD
EAST AMHERST NY
14051-1311
US

IV. Provider business mailing address

9736 TRANSIT RD
EAST AMHERST NY
14051-1311
US

V. Phone/Fax

Practice location:
  • Phone: 716-688-5717
  • Fax:
Mailing address:
  • Phone: 716-688-5717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JACQUELINE MARIE SZCZUPAKOWSKI
Title or Position: DENTIST
Credential: DDS
Phone: 716-913-4274