Healthcare Provider Details

I. General information

NPI: 1942192638
Provider Name (Legal Business Name): KYRA KATZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 RIDGE RD
WEBSTER NY
14580-2316
US

IV. Provider business mailing address

136 DENROSE DR
AMHERST NY
14228-2636
US

V. Phone/Fax

Practice location:
  • Phone: 585-671-2340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number065542
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: