Healthcare Provider Details

I. General information

NPI: 1669857504
Provider Name (Legal Business Name): ZACHARY ADAM TEACH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 UNION RD
WEST SENECA NY
14224-2900
US

IV. Provider business mailing address

1281 UNION RD
WEST SENECA NY
14224-2900
US

V. Phone/Fax

Practice location:
  • Phone: 716-675-3163
  • Fax: 716-675-3164
Mailing address:
  • Phone: 716-675-3163
  • Fax: 716-675-3164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number057982-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: