Healthcare Provider Details

I. General information

NPI: 1811196660
Provider Name (Legal Business Name): DR. JAY C. ROWLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 NIAGARA FALLS BLVD
TONAWANDA NY
14150-4734
US

IV. Provider business mailing address

2180 NIAGARA FALLS BLVD
TONAWANDA NY
14150-4734
US

V. Phone/Fax

Practice location:
  • Phone: 716-692-8600
  • Fax: 716-693-4191
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number31602
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: