Healthcare Provider Details

I. General information

NPI: 1679972160
Provider Name (Legal Business Name): MARIA GABRIELA CARRANZA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6539 ANTHONY DR STE B
VICTOR NY
14564-1441
US

IV. Provider business mailing address

6539 ANTHONY DR STE B
VICTOR NY
14564-1441
US

V. Phone/Fax

Practice location:
  • Phone: 585-924-4180
  • Fax:
Mailing address:
  • Phone: 585-924-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number059609
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: