Healthcare Provider Details

I. General information

NPI: 1518063353
Provider Name (Legal Business Name): WAYLAND DENTAL CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2288 RT 63
WAYLAND NY
14572
US

IV. Provider business mailing address

PO BOX 548 2288 RT 63
WAYLAND NY
14572
US

V. Phone/Fax

Practice location:
  • Phone: 585-728-5200
  • Fax: 585-725-3153
Mailing address:
  • Phone: 585-728-5200
  • Fax: 585-725-3153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number032949
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MARTIN P ZONE
Title or Position: OWNER PRESIDENT
Credential: DDS
Phone: 585-728-5200