Healthcare Provider Details

I. General information

NPI: 1063334373
Provider Name (Legal Business Name): COUNTY OF WAYNE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 NYE RD STE 200
LYONS NY
14489-9112
US

IV. Provider business mailing address

1519 NYE RD STE 200 SUITE 200
LYONS NY
14489-9112
US

V. Phone/Fax

Practice location:
  • Phone: 315-946-5749
  • Fax: 315-946-5749
Mailing address:
  • Phone: 315-946-5749
  • Fax: 315-946-5749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. KERRY VANAUKEN
Title or Position: DEPUTY DIRECTOR
Credential:
Phone: 315-946-5749