Healthcare Provider Details

I. General information

NPI: 1497905509
Provider Name (Legal Business Name): PETER A ROUFF DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 DELAWARE ST
TONAWANDA NY
14150-5348
US

IV. Provider business mailing address

495 DELAWARE ST
TONAWANDA NY
14150-5348
US

V. Phone/Fax

Practice location:
  • Phone: 716-693-9077
  • Fax: 716-693-9243
Mailing address:
  • Phone: 716-693-9077
  • Fax: 716-693-9243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberNY052405
License Number StateNY

VIII. Authorized Official

Name: PETRE A ROUFF
Title or Position: MEMBER/ORTHODONTIST
Credential: DMD
Phone: 716-693-9077