Healthcare Provider Details

I. General information

NPI: 1891491866
Provider Name (Legal Business Name): CHILI FAMILY DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4369 BUFFALO RD STE A
NORTH CHILI NY
14514-1236
US

IV. Provider business mailing address

5908 TWEED TRL
FARMINGTON NY
14425-8803
US

V. Phone/Fax

Practice location:
  • Phone: 585-488-5556
  • Fax:
Mailing address:
  • Phone: 716-553-7696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SANEL SADIBASIC
Title or Position: DENTIST
Credential: DDS
Phone: 716-553-7696