Healthcare Provider Details

I. General information

NPI: 1396877973
Provider Name (Legal Business Name): ORAL & MAXILLOFACIAL SURGERY ASSOCIATES OF WNY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1947 RIDGE RD
WEST SENECA NY
14224-3339
US

IV. Provider business mailing address

1947 RIDGE RD
WEST SENECA NY
14224-3339
US

V. Phone/Fax

Practice location:
  • Phone: 716-675-9777
  • Fax: 716-675-9645
Mailing address:
  • Phone: 716-675-9777
  • Fax: 716-675-9645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA LUH
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 716-675-9777