Healthcare Provider Details

I. General information

NPI: 1831498237
Provider Name (Legal Business Name): COMO PARK DENTAL ASSOCIATES,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 COMO PARK BLVD
LANCASTER NY
14086-3068
US

IV. Provider business mailing address

1965 COMO PARK BLVD
LANCASTER NY
14086-3068
US

V. Phone/Fax

Practice location:
  • Phone: 716-683-7666
  • Fax: 716-685-9265
Mailing address:
  • Phone: 716-683-7666
  • Fax: 716-685-9265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number39284
License Number StateNY

VIII. Authorized Official

Name: DR. LOUIS J. SCHIUMO
Title or Position: CO-OWNER
Credential: D.D.S.
Phone: 716-683-7666