Healthcare Provider Details

I. General information

NPI: 1386615722
Provider Name (Legal Business Name): MARTIN JOSEPH NOWAK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 DELAWARE RD
KENMORE NY
14223
US

IV. Provider business mailing address

800 DELAWARE RD
KENMORE NY
14223
US

V. Phone/Fax

Practice location:
  • Phone: 716-877-5566
  • Fax: 716-877-9580
Mailing address:
  • Phone: 716-877-5566
  • Fax: 716-877-9580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number37829
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: