Healthcare Provider Details

I. General information

NPI: 1659688109
Provider Name (Legal Business Name): ALLIANCE FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2010
Last Update Date: 09/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 PINE AVE
NIAGARA FALLS NY
14301-2309
US

IV. Provider business mailing address

1909 PINE AVE
NIAGARA FALLS NY
14301-2309
US

V. Phone/Fax

Practice location:
  • Phone: 716-282-4641
  • Fax:
Mailing address:
  • Phone: 716-282-4641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number044763-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number047088-1
License Number StateNY

VIII. Authorized Official

Name: PAULA OLIVERI
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 716-282-4641