Healthcare Provider Details

I. General information

NPI: 1427850015
Provider Name (Legal Business Name): NICHOLAS DAVID KAGELMACHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3996 WALDEN AVE
LANCASTER NY
14086-1410
US

IV. Provider business mailing address

25 BROWN ST APT 3
CHEEKTOWAGA NY
14227-2279
US

V. Phone/Fax

Practice location:
  • Phone: 716-683-2001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number065534
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: